Human Resources News & Insights

Obamacare guidance covers much ground: 7 things you need to know

In its 29th set of Frequently Asked Questions (FAQ) on the ACA, the DOL covered everything from preventive services like lactation counseling/equipment to the Mental Health Parity Act

Major focus areas

Here are the key highlights of the FAQ, which can be found here:

1. Lactation counseling/equipment. Plans must cover in-network, comprehensive prenatal and postnatal lactation support, counseling and equipment rental.

Plus, if plan participants don’t have access to in-network lactation counseling — a service that can’t be limited to inpatient services — out-of-network services must be covered at no cost.

2. Weight management. In response to a question about a plan’s exclusion for weight management services for adult obesity, the DOL clarified that such exclusions aren’t allowed. Plans must cover these weight management services for all adults, including those with certain risk factors.

3. Colonoscopies. If it’s scheduled and performed as a screening procedure, plans can’t impose any cost-sharing on any required pre-procedure consultations or pathology exams on polyp biopsies.

4. Religious accommodations. Certain companies — qualifying nonprofits, closely held for-profits — can apply for a religious accommodation to the contraceptive coverage rule by either:

  • Giving a completed EBSA Form 700 to its TPA, or
  • Providing appropriate notice of objection to HHS.

5. BRCA testing. In cases where women are at an increased risk for BRCA mutations (i.e., breast cancer susceptibility genes), plans must cover BRCA testing and genetic counseling as a preventive service.

6. Wellness rewards. Non-financial (or “in-kind”) incentives — such as water bottles, sports gear or gift cards — are subject to limits for wellness plan incentives under the ACA. The maximum incentive for a health-contingent wellness program under the ACA is 30% of the total coverage cost (50% for tobacco prevention/reduction programs).

7. Mental health parity. In the FAQs the DOL clarified that plans can’t refuse to disclose info to employees about medical necessity determinations regarding mental health or substance abuse (including denials) on the grounds the info is “proprietary” or has “commercial value.”

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