Tuesday, July 9, 2013

Bad News for TPAs and Insurers: Final Contraceptive Regulations for Religious Organizations Issued

On June 28, 2013, the Departments of Health and Human Services, Labor and Treasury issued final regulations about contraceptive coverage for religious organizations that object to covering contraceptive services.

The final rule changes the effective date from plan years beginning on or after August 1, 2013 to plan years beginning after December 31, 2013.  


  • Group health plans sponsored by religious employers such as churches do not have to cover contraceptive services.
  • Group health plans sponsored by religious non-profit organizations such as hospitals, schools, universities and charities that object to offering contraceptive coverage do not have to provide contraceptive coverage. 
  • Group health plans sponsored by for-profit, secular employers are required to cover contraceptives irrespective of religious belief.   


  • Religious non-profit organizations must self-certify that they do not want to cover contraceptives only one time – not every year. 

Burdens Shifted to TPAs and Insurers

  • For insured plans, insurers must exclude contraceptive coverage from the employer’s group plan and pay for contraceptive services separately from the employer's plan.  Hence, insurers will have to raise everyone's premium and administer this coverage on their own.   The insurer may not charge any cost sharing such as copays to plan participants.  
  • For self-funded plans, the final regulations make the TPA an ERISA plan administrator and claims administrator for the purpose of providing payments for contraceptive services. The administrator can pay for the contraceptive services or contract with an insurer to provide the benefits. 


The TPA/insurer must notify plan participants that separate contraceptive coverage is available. This notice must be provided separately from, but at the same time as, when employees receive enrollment materials for their group health plan.

Additional Information

Final regulation

Fact sheet