2018 Contraceptive Benefit Changes for Maryland and Virginia

In compliance with Maryland and Virginia state mandates, effective January 1, 2018 upon renewal, the following changes to contraceptive benefits will apply.

Maryland House Bill 1005 (Contraceptive Equity Act) requires health insurers to:

  • Provide coverage for a single dispensing of up to a six-month supply for covered, FDA approved, prescription contraceptives.
  • Apply no out-of-pocket costs for over-the-counter emergency contraceptives purchased at in-network pharmacies without a prescription.
  • Apply no out-of-pocket costs for male sterilization benefits.

Male sterilization tax warning– Under IRS rules for high deductible health plans (HDHP), only preventative care benefits can be provided without a deductible.

Maryland law requires all plans to cover male sterilization as a preventive care benefit for HDHPs. The Maryland Insurance Administration is aware of this issue and has asked the IRS for clarification as to whether they consider male sterilization to be a preventive benefit for the purpose of IRS regulatory guidance. Members with a Health Savings Account in Maryland may be subject to tax penalties if the IRS does not recognize male sterilization as a preventive benefit. A tax professional should be contacted with any questions.

Virginia House Bill 2267 requires health insurers to:

  • Provide coverage for hormonal contraception for a single dispensing of up to a 12-month supply for covered, FDA approved, prescription contraceptives at an in-network pharmacy.

    These changes apply to on and off exchange plans.

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