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Contraception Requirements for Religious Employer Exemption
April 23, 2012
The Patient Protection and Affordable Care Act requires non-grandfathered plans to cover contraceptive services for women beginning in the first plan year commencing on or after Aug. 1, 2012. Qualified religious organizations wishing to exclude contraceptive coverage from their health benefit plans must submit the appropriate Department of Health and Human Services (HHS) and/or UnitedHealthcare certification with their renewal forms to UnitedHealthcare no less than 30 days before the next renewal date.
Conditions for Exemption
The Religious Employer Exemption (REE) is available to organizations that:
- Qualify as a religious employer under state and federal law.
- Submit the UnitedHealthcare REE Certification Form as required by UnitedHealthcare.
The Temporary Enforcement Safe Harbor (TESH) is available to group health plans (and student health plans) that:
- Meet the conditions outlined in the HHS bulletin.
- Submit both the UnitedHealthcare TESH Certification and the HHS Certification to UnitedHealthcare.
- Share the HHS Notice to Plan Participants alerting them that contraception is not covered under their plan.
The Religious Employer Exemption and Temporary Enforcement Safe Harbor each require a one-time only certification to UnitedHealthcare (forms do not need to be submitted each year). Currently, the federal law provides TESH is only available for the first plan year that begins on or after Aug. 1, 2012, but the REE will be available for all future plan years.
REE and TESH Not Available for Fully Insured Clients in all States
In addition to the Act, several states require coverage of contraceptive services. However, only some states permit a religious employer exemption, and the scope of the exemptions varies among states.
Generally, state laws that provide greater consumer protections will continue to apply, and those state laws with fewer protections will be narrowed to provide the minimum protections described under the Act. This means the REE and/or TESH are not available in all states, including states that require religious employers to cover.
Neither the REE nor the TESH are available for fully insured plans in the following states: CO, GA, IL, IA, MT, NV, NH, TX, VT, VA, WA, and WI.
The TESH is not available for fully insured plans in CA, NY and OR.
Organizations are solely responsible for their own compliance with federal and state law regarding exemptions from contraceptive coverage requirements. Non-grandfathered plans who fail to submit the required certification forms will have contraceptive services included in their health plans.
Certification forms are posted on the United for Reform Resource Center, Preventive Services, under For More Information or here at:
- Instructions: Using the Certification Forms
- HHS Bulletin: Religious Exemption to Women's Preventive Care Certification and Requirements (accompanies TESH Certification Forms Only)
- UnitedHealthcare Fully Insured TESH Certification Form
- UnitedHealthcare Self-funded TESH Certification Form
- UnitedHealthcare Fully Insured REE Certification
- UnitedHealthcare Self-funded REE Certification
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The following updates will take effect for the OptumRx direct Prescription Drug Lists (PDLs) on January 1, 2018. Learn more
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