The Patient Protection and Affordable Care Act, also known as Health Care Reform, requires non-grandfathered health plans to cover contraceptive services for women with no out-of-pocket costs (i.e., $0 cost-sharing). There are two exceptions to this requirement:Religious employer exemption. Religious employers can elect not to provide contraceptive coverage, and their employees are not eligible for contraceptive coverage.Non-profit religious organization. Non-profit religious organizations can elect not to cover contraceptives for religious reasons but are not exempt as a "religious employer." For these non-profit religious organizations, Health Care Reform requires AmeriHealth to pay the cost of certain contraceptive services for eligible employees and eligible dependents of non-profit religious organizations that elect not to cover contraceptives. Eligible members within these organizations will receive a separate ID card that indicates "Contraceptive Coverage." Using this ID card, contraceptive methods approved by the U.S. Food and Drug Administration will be covered at an in-network level with no cost-sharing under the medical benefit and covered with no cost-sharing for generic products and for those brand products for which we do not have a generic equivalent under the pharmacy benefit at retail and mail order pharmacies.* For these members, it is important that only contraceptive services be billed using the ID number on the Contraceptive Coverage ID card.*

Contraceptive Coverage ID card sample

For a complete listing of medical contraceptive services, please refer to the current version of Medical Policy #00.06.02: Preventive Care Services on the Medical Policy Portal. Please contact your Network Coordinator if you have any questions about this coverage or billing.

* Contraceptive services are covered under the pharmacy benefit only if the member has an AmeriHealth prescription drug plan.