Updated HRSA Guidelines Expand Women’s Preventive Health Services That Must Be Covered Without Cost-Sharing

The HHS Health Resources and Services Administration (HRSA) has issued updated preventive services guidelines for women, which it approved on December 30, 2021. As a reminder, non-grandfathered group health plans and insurers must cover without cost-sharing certain preventive services specified by HRSA, the United State Preventive Services Task Force (USPSTF), and the CDC (see our Checkpoint article). Recommendations and guidelines are updated periodically, and plans generally must cover newly recommended services in plan years beginning on or after the date that is one year after the guideline is issued. (A recent exception required coverage within 15 days of the CDC’s recommendations regarding COVID-19 vaccinations (see our Checkpoint article).)

Updates applicable to the women’s preventive services that must be covered without cost-sharing in plan years beginning on or after December 30, 2022, include—

  • Counseling to prevent obesity in women aged 40 to 60 years with normal or overweight body mass index;

  • Double electric breast pumps, pump parts and maintenance, and breast milk storage supplies;

  • Screening for HIV infection for all adolescent and adult women aged 15 and older at least once during their lifetime, and risk assessment and prevention education beginning at age 13; and

  • Pre-pregnancy, prenatal, postpartum, and interpregnancy well-woman visits.

EBIA Comment: HRSA maintains a useful table comparing current and updated guidelines. Sponsors, administrators, and advisors of non-grandfathered plans should keep abreast of the periodic updates and ensure plan coverage and documentation are revised by the required deadlines. For more information, see EBIA’s Group Health Plan Mandates manual at Section XIV (“Coverage of Preventive Health Services”), EBIA’s Health Care Reform manual at Section XII.C (“Coverage of Preventive Health Services”), and EBIA’s Self-Insured Health Plans manual at Section XIII.C.1 (“Preventive Health Services”). You may also be interested in our upcoming webinar “Group Health Plans Quarterly Update: Q1 2022” (live on 3/24/2022).

Contributing Editors: EBIA Staff.

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