Last week we added a post about contraceptive coverage under the PPACA and what changes people could expect to see starting in August. We just received an information sheet regarding this subject from Anthem Blue Cross Blue Shield, and wanted to share it with our readers. It will be useful for our Anthem clients, and is also helpful to give people a rough idea of how the contraceptive coverage will be implemented by most carriers. There may be some small variations from one carrier to another, but in most cases things will be similar across the board, since federal legislation is guiding the changes.
The Anthem preventive care info sheet is relevant in Colorado and nine other states where Anthem operates Blue Cross Blue Shield plans, and applies to individual health insurance as well as small and large group plans.
The Anthem info sheet specifically notes that sterilization procedures for men are not included in the new contraceptive coverage – which is the conclusion I came to last week after quite a bit of reading on the subject – since all of the guidelines apply to adding contraceptive coverage to preventive care for women rather than preventive care in general.
One other notable point on the Anthem Blue Cross Blue Shield info sheet is that in the case of brand name prescription contraceptives where a generic equivalent is available under a Preferred Generic benefit, members will still have some cost sharing. The member will have to pay the difference between the price of the generic and the price of the brand name drug. This is the same way Anthem addresses the issue with other drugs where a generic equivalent is available under a Preferred Generic benefit. If a drug doesn’t have a Preferred Generic benefit, the brand name drug will be covered with no cost sharing, even if a generic is available. If you have questions about this, make sure you clear them up before filling a prescription, even after the new contraceptive coverage rules go into effect. If your doctor is prescribing a brand name contraceptive and a generic is available, you might want to have your doctor’s office call your health insurance carrier to see how the medication will be covered.
The Anthem info sheet also contains FAQs about the religious organization exemptions and transition period, overall preventive care mandates, and some details about breast pump coverage.