HELP – Birth Control coverage under the Women’s Preventive Health services mandate

Hi all, hoping for some assistance to check if this is permitted or not. As background I work in HR, am a benefits expert and am STILL having the go around here with our insurance providers. I am looking for example, legal mandates, language in government documents etc to help support this.

Right now our HDHP plans (ones with an HSA) do NOT cover one women's sterilization option with no cost share to the member.

Here is the exact language from the carrier: Carrier confirmed there is coverage on the policies for Tubal Ligation which would fall under the Women’s Preventive Health services mandate with no cost share to member (in network) unless the plan is an HSA plan. Out of network would be subject to deductible and coinsurance.

Is this allowed!? Surely they have to provide the one option under sterilization with no cost share to member for anyone covered by their insurance, not cherry picking which of the specific plans cover it…!? (we have three medical plans you can choose from, 2 PPO, and 1 HDHP.

I want to get the carrier to cover the sterilization AT NO COST TO THE MEMBER regardless of which plan they choose – but I need legal backing to do so. Any help is much appreciated, even if it is to explain that the carrier CAN make this exclusion (which would suck). Thanks!

submitted by /u/jrlbeale1
[comments]