• Home
  • What To Know
  • Posts
  • What To Know
  • Frequently Asked Questions
  • I have employer-based coverage and I know my plan is not “grandfathered.” Yet, when I recently filled my prescription for birth control pills, I was charged a co-payment. Aren’t those plans required to cover all contraceptives without cost sharing now?

I have employer-based coverage and I know my plan is not “grandfathered.” Yet, when I recently filled my prescription for birth control pills, I was charged a co-payment. Aren’t those plans required to cover all contraceptives without cost sharing now?

Most non-grandfathered plans (plans that started or made changes after March 23, 2010) must provide contraceptives and related services with no cost sharing when they are obtained through an in-network provider. Plans must cover at least one type of each of the 18 FDA approved methods for women. There are three categories of birth control pills that must be covered: combined hormone, progestin only, and extended/continuous use. However, plans may use reasonable medical management to limit the scope of oral contraceptive coverage within each of these three categories. For example, plans may cover generic oral contraceptives without cost sharing but impose some out-of-pocket charges for equivalent branded drugs. Check with your provider if there is a generic birth control pill available that will work for you. If there is no generic alternative or there is a medical reason you need to use a brand name birth control pill or device, ask your provider to help you request a “waiver” or “exception” from the insurance company. The “waiver” or “exception” would allow you to use the brand name drug or device with no co-payment.

contraceptives

Where We Are

Asheville & Western NC
Charlotte NC Metro
Raleigh-Durham NC Metro
Gainesville & North-Central FL 
Orlando, Tampa & Central FL 

Connect With Us

Hummingbird Insurance ♡ protecting what we love 

Insurance for individuals, families and employers. We specialize in employee benefits, Medicare, health, dental, vision, life & disability.

The Hummingbird Agency, LLC d/b/a Hummingbird Insurance is an independent authorized agent/agency licensed to sell and promote products from Blue Cross and Blue Shield of North Carolina (Blue Cross NC). The content contained in this site is maintained by Hummingbird Insurance. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

®, SM Registered marks of the Blue Cross and Blue Shield Association.

Privacy Notice Statement | Copyright © 2023 Hummingbird Insurance

AGENT LOGIN