DSC Health & Wellness’s Jennifer Prince finds that NYSHIP is as lacking in transparency when it comes to their implementation of the new Affordable Care Act as they are with much other benefits info

One of the most touted components of the new Affordable Care Act (ACA) is the provision that all health insurance companies must provide free access to women’s preventative health care. These services include screenings for cervical cancer, counseling on sexually transmitted infections, contraception, and screening and counseling for domestic violence.

Why are we still paying?

This particular component of the ACA went into effect on August 1, 2012, which led me to wonder: Why am I still paying a copay for birth control?

A cursory online search for the answer to this question yielded a probable culprit for the recurring copays. While there must be free access to contraception, not all brands of contraception are free. I figured my brand wasn’t covered, which is why I was still paying. So, I decided to look further into NYSHIP’s Student Employee Health Plan (SEHP), to see which contraceptives are available at no cost.

This information, however, isn’t easy to find.

Out-dated NYSHIP website

The NYSHIP SEHP Summary of Benefits—dated January 1, 2011—provided on their website obviously doesn’t take into consideration the new women’s health care provisions. My next step was to call United Healthcare to ask which contraceptives were free. When I finally got through to a living person, her answer was, “I can’t tell you which ones are free, but if you tell me the name of a medicine I can tell you how much it costs.” I am not a doctor, nor am I a pharmacist. Off the top of my head I could only name two different contraceptives because I see them advertised on TV. Both of them, by the way, still require a copay.

Since I had reached a dead end with that question, I asked where I could find a list of the free contraceptives. I was told to go to the website empireplanrxprogram.com. To be sure I understood, I specifically inquired a second time whether that site provided a list of birth control medications and their costs under the ACA. The United Healthcare representative assured me that the Flexible Formulary did include that information. The site required registration, so I let the representative go while I logged on.

One at a time

For the record, the Flexible Formulary (dated January 1, 2012) is also available on the NYSHIP website, but neither includes information about free contraceptives—nor is it a comprehensive list of all medications available. The Empire Plan website does, however, include a “Price a medication” feature that allows users to input one drug name at a time to see how much that specific medication costs if you purchase it at a pharmacy, versus purchasing a 90 day supply through the prescription mailing program. Painstakingly, I used this feature to look up all 10 contraceptives listed on the Flexible Formulary and found that not a single one was free (although the 90 day supply by mail does, in fact, provide considerable savings).

No ACA implementation info

Feeling defeated, I called United Healthcare a second time and spoke with a different representative to whom I explained my previous conversation, detailed what I steps I took on the recommended Empire Plan website and the results they yielded, and again asked, “So, where’s my free birth control?” I was put on hold for a while, and when the representative returned she told me that while the ACA’s women’s preventative services benefits went into effect on August 1st, individual health plans don’t institute the benefits change until the plan is renewed. For NYSHIP’s SEHP, the date of renewal is January 1, 2013.

Which birth control prescriptions can we expect to be free at that time? She couldn’t tell me that, but said I could go back into the empireplanrxprogram.com website and use the pricing feature all over again after the plan is renewed next year. I asked if any literature about birth control and the ACA will be provided to the plan’s users, and her answer was that, if there were, it wouldn’t come from United Healthcare, but rather from NYSHIP.

After all that, what do you need to know?
  1. If you are expecting free women’s preventative screenings and other services due to the implementation of the ACA, you’ll have to wait until January 1, 2013. Until then, copays will be required.
  2. NYSHIP lacks ACA specifics on their website, but the U.S. Department of Health and Human Services provides an overview of the coverage that we can expect when our plan is renewed and the changes go into effect.
  3. NYSHIP has not been meeting reasonable expectations when it comes to transparency regarding the specifics of our benefits and the changes we can anticipate in the coming months. The DSC’s Health and Wellness Committee will continue to advocate for your access to this vital information.

If you have any questions or suggestions about this or other NYSHIP issues, please feel free to contact us.