Agencies issue health plan guidance: Preventive services, contraception, cybersecurity

Recently, the Departments of Health and Human Services (HHS), Labor (DOL), and Treasury proposed new regulations aimed at promoting access to contraception. Separately, the Internal Revenue Service (IRS) and DOL recently published additional pieces of guidance affecting health plans. Self-funded health plan sponsors in particular should review these proposed rules and recent notices and determine what, if any, plan or process changes are needed or desired. Let’s take a closer look.

Departments’ proposed preventive, contraceptive care rules

On October 21, 2024, the departments jointly proposed amending the Affordable Care Act (ACA) rules regarding preventive and contraceptive care for nongrandfathered plans. Those regulations, if finalized, would become effective January 1, 2026, and would require nongrandfathered plans to cover certain over-the-counter (OTC) contraception without any cost sharing and without a prescription. Such OTC contraception would include male condoms, birth control, and emergency contraceptives.

The proposed rules also would require plans to disclose that OTC coverage to participants and beneficiaries. Separately, the rules attempt to clarify that any medical management program or techniques used by a plan must have an “exceptions process,” outside of the plan’s normal claims and appeals process, that isn’t unduly burdensome for medically necessary and recommended preventive services.