WASHINGTON -- The Obama administration on Monday put health insurance companies on notice that they must cover all forms of female contraception, including the patch and intrauterine devices, without imposing copayments or other charges.
In the last month, the National Women's Law Center and the Kaiser Family Foundation issued separate reports that found that insurers often flouted a federal requirement to provide free coverage of birth control for women under President Barack Obama's health care law.
Sen. Patty Murray of Washington, the senior Democrat on the Senate health committee, and Gretchen Borchelt, a vice president at the law center, praised the action by the administration.
"Insurance companies have been breaking the law, and today the Obama administration underscored that it will not tolerate these violations," Borchelt said. "It is now absolutely clear that all means all -- all unique birth control methods for women must be covered."
In addition, the administration said that insurers must cover preventive screening, genetic testing and counseling for certain women who have a family history of breast or ovarian cancer. Specifically, it said, insurers must cover testing for mutations in the BRCA1 and BRCA2 genes, which can increase a woman's risk of developing breast or ovarian cancer.
The new guidance also makes clear that insurers should cover preventive services for transgender people when a doctor finds that the services are medically appropriate -- for example, a mammogram for a transgender man who has residual breast tissue.
Insurers cannot deny coverage or charge for "sex-specific recommended preventive services" because of a person's gender identity or their sex assigned at birth, the government said.
Other services covered without copays or cost-sharing include prenatal care and other services to promote healthy pregnancies. The requirement applies to insurance plans that cover children as dependents.
"Tens of millions of women are eligible to receive coverage of recommended preventive services without having to pay a copay or deductible," said Sylvia Mathews Burwell, the secretary of health and human services. "Today we are clarifying these coverage requirements."
Federal officials also told insurers that they could not charge for anesthesia services provided in connection with colonoscopies performed as a preventive service.
Obama's health care law requires most insurance plans to cover preventive care at no additional charge to patients. That includes employer plans serving about 3 in 4 workers.
The types of services covered generally dovetail with the recommendations of a government advisory panel. Also on the list are birth control pills and other contraceptives.
Murray and other congressional Democrats had urged the administration to clarify the coverage rules. The new guidance guarantees that more women receive "the health care they are entitled to," including contraception, Murray said.
"The [Food and Drug Administration] currently identifies 18 distinct methods of contraception for women," the administration said.
But researchers at the National Women's Law Center found that some insurers lumped together several methods of contraception and covered only one or two in a category. For example, they said, some insurers did not cover the contraceptive patch or the vaginal contraceptive ring because they covered another "hormonal method" of contraception, like birth control pills.
Under the new guidance, such restrictions are not allowed. For example, it says, insurers "may not impose cost sharing on the ring or the patch."
Insurers will be required to offer at least one no-cost option in each FDA-approved category. The option provided can be a generic, but if a woman's doctor says a more expensive alternative is medically necessary, the plan must cover it without a copay.
"This has been a problem for women," said Cindy Pearson, executive director of the National Women's Health Network. "It seems like some insurers were trying to control costs under cover of medical management." Her organization advocates on reproductive health and other issues.
Insurance companies had generally denied that they were violating federal standards for coverage of preventive services. They said they were trying to comply with the law, but that federal rules did not provide enough detail.
Insurance billing is notorious for breaking down procedures into different subcategories. The new rules also made it clear that patients cannot be billed a copay for anesthesia during a colonoscopy.
"The plan or issuer may not impose cost sharing with respect to anesthesia services performed in connection with the preventive colonoscopy if the attending provider determines that anesthesia would be medically appropriate for the individual," the Department of Health and Human Services said in its guidance document.
The new guidance was provided in a series of questions and answers issued jointly by the Departments of Health and Human Services, Labor and the Treasury.
For insurers, the new government requirements take effect in 60 days. In practice, most consumers will not notice major changes until their coverage renews for 2016.
Information for this article was contributed by Robert Pear of The New York Times and by Ricardo Alonso-Zaldivar of The Associated Press.
A Section on 05/12/2015