Health Care Reform Update: Religious Employer Exemption & Eligible Organization Accommodation for Religious Affiliated Organizations

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1 Date: December 13, 2013 Market: All Health Care Reform Update: Religious Employer Exemption & Eligible Organization Accommodation for Religious Affiliated Organizations Background Regulations implementing the Patient Protection and Affordable Care Act (known as the ACA or Federal Health Care Reform) effective August 1, 2012 included a benefit for FDA approved contraceptive methods* at no cost to members. The regulations included a provision that allowed groups meeting the federal definition of a religious employer to request an exemption from offering contraceptive coverage. Requests for exemption were reviewed by Mandates Implementation to ensure that CareFirst BlueCross BlueShield (CareFirst) appropriately administers the exclusion based on the federal definition of a religious employer. Update on Religious Exemption Effective for plan years beginning on or after August 1, 2013, the regulations define a religious employer as an organization that is organized and operates as a non-profit entity and is referred to in section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code of 1986, as amended. Religious exemption requests no longer require Mandate Implementation review or a special form. The employer can self-certify on their company letterhead that they meet the IRS criteria and want to be exempt from offering their employees contraceptive coverage. Eligible Organization Religious Accommodation (For Plans Sold Off-SHOP) Effective for plan years beginning on or after January 1, 2014, an employer that does not meet the IRS definition of a religious employer eligible for exemption may qualify as an eligible organization to request an accommodation from providing contraceptive services. An Eligible Organization is defined as a nonprofit organization that holds itself out as a religious organization and has religious objections to including coverage of contraceptives services in its group health plan. Accommodation means that the employer will not contract, arrange, pay, or refer for contraceptive coverage. A member of an accommodated group is covered for contraceptive services at no cost by an in-network provider for as long as the member is enrolled in the group health plan. CareFirst will pay claims for these members and segregate the cost of providing these services from all financial, underwriting, and actuarial activities related to the group. *Includes surgical, prescription, medical and OTC services/products. Sterilization is considered a contraceptive method. Abortion IS NOT considered a contraceptive method. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association.

2 CareFirst will offer groups two options for Accommodation: Exclude all contraception services -OR- Emergency contraceptives only (Example: Plan B, commonly known as the morning after pill ) Self-certification is a one-time requirement and a group renewing with CareFirst in future years will not have to self-certify again. Once a group has certified for the Accommodation, CareFirst is required to notify employees that coverage for contraceptive services is not covered under their group health plan benefits, but will be covered by CareFirst. A notification Member letter for small to mid-groups and a sample Notice is attached to this Broker Flash. Summary Both Religious Employers and Eligible Organizations share the following requirements: Exemption or Accommodation Status cannot be challenged by CareFirst Contraceptive services are excluded from group contracts, rates & premiums The differences between Religious Employer Exemption for Contraceptive Services and Eligible Organization Accommodation for Contraceptive Services are summarized in the table below: Religious Employer vs. Eligible Organization Comparison Religious Employer Exempted from contraceptive services Nonprofit Method of self-certification not defined Religious Employer notifies employees Employees do not have any coverage for contraceptive services CareFirst has already implemented processes for Exemption Eligible Organization Accommodated for contraceptive services Nonprofit HHS and DOL-defined self-certification form CareFirst notifies employees Contraceptive services are paid by CareFirst at no cost to employees when provided by an in-network provider New processes defined for Accommodation Should you have any questions, please contact your Broker Sales Representative. C. Shekar Subramaniam Associate Vice President, Broker Sales CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are both independent licensees of the Blue Cross and Blue Shield Association.

3 December 13, 2013 Dear Member: Thank you for choosing CareFirst BlueCross BlueShield as your health insurance carrier. Your business is important to us and we want to be sure that you understand any changes made to your health plan. Under the Affordable Care Act, employers with religious objections to providing contraceptive services as part of their group health plan coverage may qualify as an eligible organization and exclude contraceptive services from their group health plan benefits. While the employer may exclude the benefits, employees will still receive contraceptive benefits under an accommodation. The accommodation provides that the cost of contraceptive services for members of the employer s health care plan will be reimbursed by CareFirst, when provided by an in-network provider, for as long as the member is covered under the employer s health care plan. Your employer has certified that your group health plan qualifies for an accommodation with respect to the federal requirement to cover all Food and Drug Administration-approved contraceptive services for women, as prescribed by a health care provider, without cost sharing. This means that your employer will not contract, arrange, pay, or refer for contraceptive coverage. Instead, CareFirst will provide in-network contraceptive services that you use, without cost sharing, for so long as you are enrolled in your group health plan. Your employer will not administer or fund these payments. If you have any questions about this notice, please contact Customer Service at the number listed on your ID card. Sincerely, Julie Fisher Director, Operations MBR4941 CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association.

4 CareFirst BlueChoice, Inc. 840 First Street, NE Washington, DC An independent licensee of the Blue Cross and Blue Shield Association NOTICE OF AVAILABILITY OF SEPARATE PAYMENTS FOR CONTRACEPTIVE SERVICES Your employer (the Group ) has certified that it is an organization that qualifies under the Affordable Care Act for an accommodation with respect to the requirement to cover contraceptive services and contraceptive drugs and devices for women. YOUR GROUP HEALTH PLAN EXCLUDES BENEFITS FOR CONTRACEPTIVE SERVICES FOR WOMEN Your group health plan (the Evidence of Coverage ) includes a Religious Organization Exclusion Rider. This means that, among other things, the Evidence of Coverage does not cover, contract, arrange, or pay for the following contraceptive benefits for female Members: 1. Contraceptive patient education and counseling for all female Members with reproductive capacity; 2. All FDA-approved contraceptive drugs and devices for all female Members, and sterilization procedures and other contraceptive methods for female Members that must be administered to the female Member in the course of a covered outpatient or inpatient treatment; 3. The insertion or removal, and any medically necessary examination associated with the use of any contraceptive devices or drugs that are approved by the FDA; 4. Any self-administered contraceptive drug or device that is approved by the FDA for use as a contraceptive or 5. Female elective sterilization procedures and any related services. (Collectively, the Contraceptive Services ). CAREFIRST BLUECHOICE WILL MAKE CONTRACEPTIVE SERVICES AVAILABLE TO ENROLLED FEMALE MEMBERS UNDER THE TERMS OF THIS NOTICE CareFirst BlueChoice will make Contraceptive Services available when provided, as appropriate, by a Pharmacy that contracts with CareFirst BlueChoice (a CareFirst BlueChoice Contracting Pharmacy ) or a health care provider that is a CareFirst BlueChoice Contracting Provider, to an enrolled female Member at no cost for so long as that person is enrolled under the Evidence of Coverage. You must obtain Contraceptive Services from a CareFirst BlueChoice Contracting Provider or CareFirst BlueChoice Contracting Pharmacy. You can find a CareFirst BlueChoice Contracting Provider or CareFirst BlueChoice Contracting Pharmacy in your area on CareFirst BlueChoice s website, or by calling Member Services at the telephone number on the back of your identification card. CFBC/ACA CONTR NOTICE (1/14) 1 All HMO, BCOO, BCOOPOA & HCR Products

5 EXCLUSIONS AND LIMITATIONS The Contraceptive Services made available under this Notice are subject to the following limitations and exclusions: 1. The Contraceptive Services made available under this Notice exclude any service provided by a health care provider that is not a CareFirst BlueChoice Contracting Provider. 2. The Contraceptive Services made available under this Notice exclude self-administered contraceptive drugs or devices that are obtained from a Pharmacy that is not a CareFirst BlueChoice Contracting Pharmacy. 3. Self-administered FDA-approved contraceptive drugs or devices that are not included on CareFirst BlueChoice s Preferred Preventive Drug List require prior authorization from CareFirst BlueChoice and will not be made available unless medically necessary. A copy of the CareFirst BlueChoice Preferred Preventive Drug List is available to you by calling Member Services at the telephone number below or at the telephone number on the back of your identification card. 4. The Contraceptive Services made available under this Notice exclude any drug or device that has not been approved by the FDA for use as a contraceptive. 5. The Contraceptive Services made available under this Notice exclude abortion services and exclude mifepristone, methotrexate, misoprostol, or any other drug or compound not identified or described in this Notice that is used to induce an abortion. 6. Members who are male are not eligible to receive Contraceptive Services under this Notice. 7. The Contraceptive Services made available under to this Notice will terminate when the female Member s enrollment under the Evidence of Coverage terminates. The Group will not administer or fund the Contraceptive Services made available to female Members under this Notice. QUESTIONS OR COMPLAINTS If you have any questions about this Notice, contact CareFirst BlueChoice at the Member Services telephone number provided on your identification card. You can also contact CareFirst BlueChoice in writing at: Mail Administrator P.O. Box Lexington, KY Any complaints or disputes relating to Contraceptive Services made available pursuant to this Notice will be handled pursuant to the Benefit Determinations and Appeal and Grievance Procedures in the Evidence of Coverage. CFBC/ACA CONTR NOTICE (1/14) 2 All HMO, BCOO, BCOOPOA & HCR Products