New Regulations Broadening Employer Exemptions to Contraceptive Coverage: For Many Women, Their Employers Will Determine Whether They Have No-cost Coverage to the Full Range of FDA Approved Methods

Figure 1: Employers Objecting to Contraceptive Coverage: Exemptions and Accommodations Under the Trump Administration Regulations

The accommodation will be available to employers that previously qualified for the accommodation. They now will also have the choice of an exemption. It is not known how many of the religiously affiliated nonprofits and closely held for-profits that are currently using the accommodation will opt for an exemption and thus eliminate contraceptive coverage for their workers or students. The federal departments issuing the regulations posit that these new rules will have limited impact on the number of women losing contraceptive coverage. However, it is not clear how many employers previously utilizing the accommodation will now opt for an exemption, resulting in the loss of contraceptive coverage for their employees and dependents. In addition, there are also an unknown number of organizations that were not previously eligible for either the accommodation or exemption that may now opt for an exemption. These new regulations create two new categories of employers who can now qualify for an exemption or can voluntarily chooses an accommodation: 1) publicly traded for-profit companies with a religious objection and 2) nonprofit and closely held for-profit employers who have a moralobjection to contraceptives, a considerably larger pool of employers than when the exemption was available only to those who were employees of a house of worship or who were eligible for an accommodation in the past.

Table 1: Summary of Changes in the Contraceptive Coverage Regulations for Objecting Entities
	Obama Administration August 2012 to October 5, 2017	Trump Administration Effective October 6, 2017
What types of contraceptives must plans cover without cost-sharing?	At least one of each of the 18 FDA approved contraceptive methods for women, as prescribed, along with counseling and related services must be covered without cost-sharing.	No change
Are any employers “exempt” from the contraceptive mandate?	Religious institutions defined as “houses of worship” Grandfathered plans No notice to employees is required. Women workers and female dependents must pay for their own contraceptives.	Religious institutions defined as “houses of worship” Grandfathered plans Nonprofit or for-profit employers (including publicly traded companies), insurers, or private colleges or universities that issue student insurance plans with a religious objection to contraceptive coverage Nonprofit or closely held for-profit employers, insurers, or private colleges or universities that issue student insurance plans with a moralobjection to contraceptive coverage Notice is only required if the plan previously included contraceptive coverage. Women workers and female dependents must pay for their own contraceptives.
Who pays for contraceptive coverage for employees of organizations receiving an exemption?	The cost of contraceptives is borne by women workers and female dependents. There is no guarantee of contraceptive coverage for employees of an exempt organization. The employer may choose to cover some methods, but has no obligation to cover all 18 FDA methods without cost sharing	No change
What type of employers may seek an “accommodation” to avoid paying for contraceptives in their plans?	Closely held for-profit corporations and religiously affiliated nonprofits with religious objections to contraception can opt out of providing and paying for contraceptive coverage Notice must be provided to either their insurer, third party administrator, or the federal government of their objection. Women workers and female dependents receive no cost contraceptive coverage.	Any entity (except for houses of worship) eligible for an exemption can choose the accommodation instead of the exemption. Notice must be provided to either their insurer, third party administrator, or the federal government of their objection. Women workers and female dependents receive no cost contraceptive coverage.
Who pays for contraceptive coverage for employees of organizations receiving an accommodation?	Insurance companies of firms obtaining an accommodation must pay for contraceptive coverage. Third-party administrators (TPA) of self-funded health plans must cover the costs of contraceptives for employees. The costs of the benefit are offset by reductions in the fees the TPA pays to participate in the federal exchange.	No change
When can entities change from an accommodation to an exemption?	N/A	When an employer or private college or university currently using the accommodation opts for an exemption, the revocation of contraceptive coverage will be effective on the first day of the first plan year that begins 30 days after the date of the revocation or 60 days notice may be given in a summary of benefits statement. The issuer or third party administrator is responsible for providing the notice to the beneficiaries.

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New Regulations Broadening Employer Exemptions to Contraceptive Coverage: For Many Women, Their Employers Will Determine Whether They Have No-cost Coverage to the Full Range of FDA Approved Methods

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