Contraceptive Coverage for Federal Employees

Benefit Description

You Pay

Preventive care benefits for women such as Pap smears, gonorrhea prophylactic medication to protect newborns, annual counseling for sexually transmitted infections, contraceptive methods, and screening for interpersonal and domestic violence. For a complete list of preventive care benefits for women go to the Health and Human Services (HHS) website at https://www.healthcare.gov/preventive-care-women/

• Contraceptive counseling on an annual basis
• A range of voluntary family planning services, limited to:
  • Surgically implanted contraceptives
  • Injectable contraceptive drugs (such as Depo Provera)
  • Intrauterine devices (IUDs)
  • Diaphragms
  • Tubal ligation

Note: We cover oral contraceptives under the prescription drug benefit.

• Voluntary sterilization (See Surgical Procedures Section 5 (b)

Contraceptive drugs and devices prescribed by a health care professional and obtained from a Plan pharmacy or through our mail order program.

Contraceptive drugs and devices as listed in the ACA/HRSA site. Contraceptive coverage is available at no cost to FEHB members. The contraceptive benefit includes at least one option in all methods of contraception (as well as the screening, education, counseling, and follow-up care). Any contraceptive that is not already available without cost sharing on the formulary can be accessed through the Contraceptive Exceptions Process described below.

• To initiate an exception request, a Plan physician (or member or member’s representative) may submit via facsimile or telephone information about the member’s diagnosis, other therapies tried, and medical necessity rationale to the Plan. GHC-SCW Pharmacy Administration may be contacted via telephone at 608-828-4811 for questions about the exceptions process.

The “morning after pill” is considered preventive service under contraceptives, with no cost to the member if prescribed by a physician and purchased at a network pharmacy. The “morning after pill” should be addressed under the pharmacy benefit as an over-the counter (OTC) emergency contraceptive drug