45 CFR 147.133 Moral Exceptions and CFR on Religious Exceptions

§147.133 Moral exemptions in connection with coverage of certain preventive health services. 

(a)  Objecting entities.  (1) Guidelines issued under §147.130(a)(1)(iv) by the Health
Resources and Services Administration must not provide for or support the requirement of
coverage or payments for contraceptive services with respect to a group health plan established
or maintained by an objecting organization, or health insurance coverage offered or arranged by
an objecting organization, and thus the Health Resources and Service Administration will
exempt from any guidelines’ requirements that relate to the provision of contraceptive services:
(i)  A group health plan and health insurance coverage provided in connection with a
group health plan to the extent one of the following non-governmental plan sponsors object as
specified in paragraph (a)(2) of this section:
(A)  A nonprofit organization; or
(B)  A for-profit entity that has no publicly traded ownership interests (for this purpose, a
publicly traded ownership interest is any class of common equity securities required to be
registered under section 12 of the Securities Exchange Act of 1934); 
(ii)  An institution of higher education as defined in 20 U.S.C. 1002 in its arrangement of
student health insurance coverage, to the extent that institution objects as specified in paragraph
(a)(2) of this section.  In the case of student health insurance coverage, this section is applicable
in a manner comparable to its applicability to group health insurance coverage provided in
connection with a group health plan established or maintained by a plan sponsor that is an
employer, and references to “plan participants and beneficiaries” will be interpreted as references
to student enrollees and their covered dependents; and
(iii)  A health insurance issuer offering group or individual insurance coverage to the
extent the issuer objects as specified in paragraph (a)(2) of this section.  Where a health
insurance issuer providing group health insurance coverage is exempt under paragraph (a)(1)(iii)
of this section, the group health plan established or maintained by the plan sponsor with which
the health insurance issuer contracts remains subject to any requirement to provide coverage for
contraceptive services under Guidelines issued under §147.130(a)(1)(iv) unless it is also exempt
from that requirement.
(2)  The exemption of this paragraph (a) will apply to the extent that an entity described
in paragraph (a)(1) of this section objects to its establishing, maintaining, providing, offering, or
arranging (as applicable) coverage or payments for some or all contraceptive services, or for a
plan, issuer, or third party administrator that provides or arranges such coverage or payments,
based on its sincerely held moral convictions.
(b)  Objecting individuals.  Guidelines issued under §147.130(a)(1)(iv) by the Health
Resources and Services Administration must not provide for or support the requirement of
coverage or payments for contraceptive services with respect to individuals who object as
specified in this paragraph (b), and nothing in §147.130(a)(1)(iv), 26 CFR 54.9815–
2713(a)(1)(iv), or 29 CFR 2590.715-2713(a)(1)(iv) may be construed to prevent a willing health
insurance issuer offering group or individual health insurance coverage, and as applicable, a
willing plan sponsor of a group health plan, from offering a separate policy, certificate or
contract of insurance or a separate group health plan or benefit package option, to any individual
who objects to coverage or payments for some or all contraceptive services based on sincerely
held moral convictions.


RELIGIOUS EXCEPTIONS

 

DEPARTMENT OF LABOR 

Employee Benefits Security Administration 

For the reasons set forth in the preamble, the Department of Labor amends 29 CFR part 

2590 as follows: 

PART 2590—RULES AND REGULATIONS FOR GROUP HEALTH PLANS 

            6.  The authority citation for part 2590 continues to read as follows: 

            AUTHORITY: 29 U.S.C. 1027, 1059, 1135, 1161-1168, 1169, 1181-1183, 1181 note, 

1185, 1185a, 1185b, 1191, 1191a, 1191b, and 1191c; sec. 101(g), Pub. L. 104-191, 110 Stat. 

1936; sec. 401(b), Pub. L. 105-200, 112 Stat. 645 (42 U.S.C. 651 note); sec. 512(d), Pub. L. 110-

343, 122 Stat. 3881; sec. 1001, 1201, and 1562(e), Pub. L. 111-148, 124 Stat. 119, as amended 

by Pub. L. 111-152, 124 Stat. 1029; Division M, Pub. L. 113-235, 128 Stat. 2130; Secretary of 

Labor's Order 1-2011, 77 FR 1088 (Jan. 9, 2012). 

7.  Section 2590.715-2713 is amended by revising paragraphs (a)(1) introductory text and 

(a)(1)(iv) to read as follows: 

§ 2590.715-2713 Coverage of preventive health services. 

            (a)  Services--(1)  In general. Beginning at the time described in paragraph (b) of this section and subject to § 2590.715-2713A, a group health plan, or a health insurance issuer offering group health insurance coverage, must provide coverage for and must not impose any cost-sharing requirements (such as a copayment, coinsurance, or a deductible) for— 

*     *     *     *     *    

            (iv)  With respect to women, such additional preventive care and screenings not described in paragraph (a)(1)(i) of this section as provided for in comprehensive guidelines supported by  the Health Resources and Services Administration for purposes of section 2713(a)(4) of the 

Public Health Service Act, subject to 45 CFR 147.131 and 147.132. 

*     *     *     *     *    

            8.  Section 2590.715-2713A is revised to read as follows: 

§ 2590.715-2713A   Accommodations in connection with coverage of preventive health services. 

(a)  Eligible organizations for optional accommodation.  An eligible organization is an organization that meets the criteria of paragraphs (a)(1) through (4) of this section. 

(1)  The organization is an objecting entity described in 45 CFR 147.132(a)(1)(i) or (ii); 

(2)  Notwithstanding its exempt status under 45 CFR 147.132(a), the organization voluntarily seeks to be considered an eligible organization to invoke the optional accommodation under paragraph (b) or (c) of this section as applicable; and 

(3)  [Reserved] 

(4)  The organization self-certifies in the form and manner specified by the Secretary or provides notice to the Secretary of the Department of Health and Human Services as described in paragraph (b) or (c) of this section.  To qualify as an eligible organization, the organization must make such self-certification or notice available for examination upon request by the first day of the first plan year to which the accommodation in paragraph (b) or (c) of this section applies.  

The self-certification or notice must be executed by a person authorized to make the certification or provide the notice on behalf of the organization, and must be maintained in a manner consistent with the record retention requirements under section 107 of ERISA. 

(5)  An eligible organization may revoke its use of the accommodation process, and its issuer or third party administrator must provide participants and beneficiaries written notice of  

such revocation as specified in guidance issued by the Secretary of the Department of Health and Human Services.  If contraceptive coverage is currently being offered by an issuer or third party administrator through the accommodation process, the revocation will be effective on the first day of the first plan year that begins on or after 30 days after the date of the revocation (to allow for the provision of notice to plan participants in cases where contraceptive benefits will no longer be provided).  Alternatively, an eligible organization may give 60-days notice pursuant to PHS Act section 2715(d)(4) and § 2590.715-2715(b), if applicable, to revoke its use of the accommodation process. 

(b)  Optional accommodation - self-insured group health plans. (1)  A group health plan established or maintained by an eligible organization that provides benefits on a self-insured basis may voluntarily elect an optional accommodation under which its third party administrator(s) will provide or arrange payments for all or a subset of contraceptive services for one or more plan years.  To invoke the optional accommodation process: 

(i)  The eligible organization or its plan must contract with one or more third party administrators. 

(ii)  The eligible organization must provide either a copy of the self-certification to each third party administrator or a notice to the Secretary of the Department of Health and Human Services that it is an eligible organization and of its objection as described in 45 CFR 147.132 to coverage of all or a subset of contraceptive services. 

(A)  When a copy of the self-certification is provided directly to a third party administrator, such self-certification must include notice that obligations of the third party administrator are set forth in § 2510.3-16 of this chapter and this section.   

  

(B)  When a notice is provided to the Secretary of Health and Human Services, the notice must include the name of the eligible organization; a statement that it objects as described in 45 CFR 147.132 to coverage of some or all contraceptive services (including an identification of the subset of contraceptive services to which coverage the eligible organization objects, if applicable), but that it would like to elect the optional accommodation process; the plan name and type (that is, whether it is a student health insurance plan within the meaning of 45 CFR 

147.145(a) or a church plan within the meaning of section 3(33) of ERISA); and the name and contact information for any of the plan’s third party administrators.  If there is a change in any of the information required to be included in the notice, the eligible organization must provide updated information to the Secretary of the Department of Health and Human Services for the optional accommodation process to remain in effect.  The Department of Labor (working with the Department of Health and Human Services), will send a separate notification to each of the plan’s third party administrators informing the third party administrator that the Secretary of the Department of Health and Human Services has received a notice under paragraph (b)(1)(ii) of this section and describing the obligations of the third party administrator under § 2510.3-16 of 

this chapter and this section. 

(2)  If a third party administrator receives a copy of the self-certification from an eligible organization or a notification from the Department of Labor, as described in paragraph (b)(1)(ii) of this section, and is willing to enter into or remain in a contractual relationship with the eligible organization or its plan to provide administrative services for the plan, then the third party administrator will provide or arrange payments for contraceptive services, using one of the following methods—  

(i)  Provide payments for the contraceptive services for plan participants and beneficiaries without imposing any cost-sharing requirements (such as a copayment, coinsurance, or a deductible), premium, fee, or other charge, or any portion thereof, directly or indirectly, on the eligible organization, the group health plan, or plan participants or beneficiaries; or  

(ii)  Arrange for an issuer or other entity to provide payments for contraceptive services for plan participants and beneficiaries without imposing any cost-sharing requirements (such as a copayment, coinsurance, or a deductible), premium, fee, or other charge, or any portion thereof, directly or indirectly, on the eligible organization, the group health plan, or plan participants or beneficiaries. 

(3)  If a third party administrator provides or arranges payments for contraceptive services in accordance with either paragraph (b)(2)(i) or (ii) of this section, the costs of providing or arranging such payments may be reimbursed through an adjustment to the Federally facilitated Exchange user fee for a participating issuer pursuant to 45 CFR 156.50(d). 

(4)  A third party administrator may not require any documentation other than a copy of the self-certification from the eligible organization or notification from the Department of Labor described in paragraph (b)(1)(ii) of this section.  

(5) Where an otherwise eligible organization does not contract with a third party administrator and it files a self-certification or notice under paragraph (b)(1)(ii) of this section, the obligations under paragraph (b)(2) of this section do not apply, and the otherwise eligible organization is under no requirement to provide coverage or payments for contraceptive services to which it objects.  The plan administrator for that otherwise eligible organization may, if it and the otherwise eligible organization choose, arrange for payments for contraceptive services from  

an issuer or other entity in accordance with paragraph (b)(2)(ii) of this section, and such issuer or other entity may receive reimbursements in accordance with paragraph (b)(3) of this section. 

(c)  Optional accommodation - insured group health plans—(1)  General rule. A group health plan established or maintained by an eligible organization that provides benefits through one or more group health insurance issuers may voluntarily elect an optional accommodation under which its health insurance issuer(s) will provide payments for all or a subset of contraceptive services for one or more plan years.  To invoke the optional accommodation process: 

(i)  The eligible organization or its plan must contract with one or more health insurance issuers. 

(ii)  The eligible organization must provide either a copy of the self-certification to each issuer providing coverage in connection with the plan or a notice to the Secretary of the Department of Health and Human Services that it is an eligible organization and of its objection as described in 45 CFR 147.132 to coverage for all or a subset of contraceptive services. 

(A) When a self-certification is provided directly to an issuer, the issuer has sole responsibility for providing such coverage in accordance with § 2590.715-2713.  

(B)  When a notice is provided to the Secretary of the Department of Health and Human Services, the notice must include the name of the eligible organization; a statement that it objects as described in 45 CFR 147.132 to coverage of some or all contraceptive services (including an identification of the subset of contraceptive services to which coverage the eligible organization objects, if applicable) but that it would like to elect the optional accommodation process; the plan name and type (that is, whether it is a student health insurance plan within the meaning of 45 

CFR 147.145(a) or a church plan within the meaning of section 3(33) of ERISA); and the name  

and contact information for any of the plan’s health insurance issuers.  If there is a change in any of the information required to be included in the notice, the eligible organization must provide updated information to the Secretary of Department Health and Human Services for the optional accommodation process to remain in effect.  The Department of Health and Human Services will send a separate notification to each of the plan’s health insurance issuers informing the issuer 

that the Secretary of Health and Human Services has received a notice under paragraph (c)(2)(ii) of this section and describing the obligations of the issuer under this section. 

(2)  If an issuer receives a copy of the self-certification from an eligible organization or the notification from the Department of Health and Human Services as described in paragraph (c)(2)(ii) of this section and does not have its own objection as described in 45 CFR 147.132 to 

providing the contraceptive services to which the eligible organization objects, then the issuer will provide payments for contraceptive services as follows—   

(i)  The issuer must expressly exclude contraceptive coverage from the group health insurance coverage provided in connection with the group health plan and provide separate payments for any contraceptive services required to be covered under § 2590.715-2713(a)(1)(iv) for plan participants and beneficiaries for so long as they remain enrolled in the plan. 

            (ii)  With respect to payments for contraceptive services, the issuer may not impose any cost-sharing requirements (such as a copayment, coinsurance, or a deductible), or impose any premium, fee, or other charge, or any portion thereof, directly or indirectly, on the eligible organization, the group health plan, or plan participants or beneficiaries. The issuer must segregate premium revenue collected from the eligible organization from the monies used to provide payments for contraceptive services. The issuer must provide payments for contraceptive 

services in a manner that is consistent with the requirements under sections 2706, 2709, 2711,  

2713, 2719, and 2719A of the PHS Act, as incorporated into section 715 of ERISA.  If the group health plan of the eligible organization provides coverage for some but not all of any contraceptive services required to be covered under § 2590.715-2713(a)(1)(iv), the issuer is required to provide payments only for those contraceptive services for which the group health plan does not provide coverage.  However, the issuer may provide payments for all contraceptive services, at the issuer’s option. 

(3)  A health insurance issuer may not require any documentation other than a copy of the self-certification from the eligible organization or the notification from the Department of Health and Human Services described in paragraph (c)(1)(ii) of this section.   

(d)  Notice of availability of separate payments for contraceptive services - self-insured 

and insured group health plans.  For each plan year to which the optional accommodation in paragraph (b) or (c) of this section is to apply, a third party administrator required to provide or arrange payments for contraceptive services pursuant to paragraph (b) of this section, and an 

issuer required to provide payments for contraceptive services pursuant to paragraph (c) of this section, must provide to plan participants and beneficiaries written notice of the availability of separate payments for contraceptive services contemporaneous with (to the extent possible), but separate from, any application materials distributed in connection with enrollment (or re-enrollment) in group health coverage that is effective beginning on the first day of each applicable plan year.  The notice must specify that the eligible organization does not administer 

or fund contraceptive benefits, but that the third party administrator or issuer, as applicable, provides or arranges separate payments for contraceptive services, and must provide contact information for questions and complaints.  The following model language, or substantially 

similar language, may be used to satisfy the notice requirement of this paragraph (d): “Your   

employer has certified that your group health plan qualifies for an accommodation with respect to the Federal requirement to cover all Food and Drug Administration-approved contraceptive services for women, as prescribed by a health care provider, without cost sharing.  This means that your employer will not contract, arrange, pay,or refer for contraceptive coverage. Instead, [name of third party administrator/health insurance issuer] will provide or arrange separate 

payments for contraceptive services that you use, without cost sharing and at no other cost, for so long as you are enrolled in your group health plan.  Your employer will not administer or fund these payments.  If you have any questions about this notice, contact [contact information for third party administrator/health insurance issuer].” 

(e)  Definition.  For the purposes of this section, reference to “contraceptive” services, benefits, or coverage includes contraceptive or sterilization items, procedures, or services, or related patient education or counseling, to the extent specified for purposes of § 2590.715-

2713(a)(1)(iv). 

            (f)  Severability.  Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, shall be construed so as to continue to give maximum effect to the provision permitted by law, unless such holding shall be one of utter invalidity or unenforceability, in which event the provision shall be severable from this section and shall not affect the remainder thereof or the application of the provision to persons not similarly situated or to dissimilar circumstances. 

                                                 

CMS-9940-IFC                                                            155  

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

For the reasons set forth in the preamble, the Department of Health and Human Services 

amends 45 CFR part 147 as follows: 

PART 147—HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP 

AND INDIVIDUAL HEALTH INSURANCE MARKETS 

9.  The authority citation for part 147 continues to read as follows: 

Authority:  Secs 2701 through 2763, 2791, and 2792 of the Public Health Service Act 

(42 USC 300gg through 300gg-63, 300gg-91, and 300gg-92), as amended. 

10.  Section 147.130 is amended by revising paragraphs (a)(1) introductory text and 

(a)(1)(iv) to read as follows: 

§ 147.130 Coverage of preventive health services. 

(a) *     *     *      

(1)  In general.  Beginning at the time described in paragraph (b) of this section and subject to §§ 147.131 and 147.132, a group health plan, or a health insurance issuer offering group or individual health insurance coverage, must provide coverage for and must not impose any cost-sharing requirements (such as a copayment, coinsurance, or a deductible) for— 

*     *     *     *     *  

(iv) With respect to women, such additional preventive care and screenings not described in paragraph (a)(1)(i) of this section as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of section 2713(a)(4) of the 

Public Health Service Act, subject to §§ 147.131 and 147.132. 

*     *     *     *     * 

            11.  Section 147.131 is revised to read as follows:  

CMS-9940-IFC                                                            156  

§ 147.131 Accommodations in connection with coverage of certain preventive health 

services. 

            (a) – (b)  [Reserved] 

            (c)  Eligible organizations for optional accommodation.  An eligible organization is an organization that meets the criteria of paragraphs (c)(1) through (3) of this section. 

(1)  The organization is an objecting entity described in § 147.132(a)(1)(i) or (ii). 

(2)  Notwithstanding its exempt status under § 147.132(a), the organization voluntarily 

seeks to be considered an eligible organization to invoke the optional accommodation under paragraph (d) of this section; and 

(3)  The organization self-certifies in the form and manner specified by the Secretary or provides notice to the Secretary as described in paragraph (d) of this section.  To qualify as an eligible organization, the organization must make such self-certification or notice available for examination upon request by the first day of the first plan year to which the accommodation in paragraph (d) of this section applies.  The self-certification or notice must be executed by a person authorized to make the certification or provide the notice on behalf of the organization, 

and must be maintained in a manner consistent with the record retention requirements under section 107 of ERISA. 

(4)  An eligible organization may revoke its use of the accommodation process, and its issuer must provide participants and beneficiaries written notice of such revocation as specified in guidance issued by the Secretary of the Department of Health and Human Services.  If contraceptive coverage is currently being offered by an issuer through the accommodation process, the revocation will be effective on the first day of the first plan year that begins on or 

after 30 days after the date of the revocation (to allow for the provision of notice to plan  

participants in cases where contraceptive benefits will no longer be provided).  Alternatively, an eligible organization may give 60-days notice pursuant to section 2715(d)(4) of the PHS Act and § 147.200(b), if applicable, to revoke its use of the accommodation process. 

(d)  Optional accommodation—insured group health plans—(1)  General rule.  A group health plan established or maintained by an eligible organization that provides benefits through one or more group health insurance issuers may voluntarily elect an optional accommodation under which its health insurance issuer(s) will provide payments for all or a subset of contraceptive services for one or more plan years.  To invoke the optional accommodation process: 

(i)  The eligible organization or its plan must contract with one or more health insurance issuers. 

(ii)  The eligible organization must provide either a copy of the self-certification to each issuer providing coverage in connection with the plan or a notice to the Secretary of the Department of Health and Human Services that it is an eligible organization and of its objection as described in § 147.132 to coverage for all or a subset of contraceptive services. 

(A)  When a self-certification is provided directly to an issuer, the issuer has sole responsibility for providing such coverage in accordance with § 147.130(a)(iv).  

(B)  When a notice is provided to the Secretary of the Department of Health and Human Services, the notice must include the name of the eligible organization; a statement that it objects as described in § 147.132 to coverage of some or all contraceptive services (including an identification of the subset of contraceptive services to which coverage the eligible organization objects, if applicable) but that it would like to elect the optional accommodation process; the plan name and type (that is, whether it is a student health insurance plan within the meaning of §  

147.145(a) or a church plan within the meaning of section 3(33) of ERISA); and the name and contact information for any of the plan’s health insurance issuers.  If there is a change in any of the information required to be included in the notice, the eligible organization must provide updated information to the Secretary of the Department of Health and Human Services for the optional accommodation to remain in effect.  The Department of Health and Human Services will send a separate notification to each of the plan’s health insurance issuers informing the 

issuer that the Secretary of the Deparement of Health and Human Services has received a notice under paragraph (d)(1)(ii) of this section and describing the obligations of the issuer under this section.  

(2)  If an issuer receives a copy of the self-certification from an eligible organization or the notification from the Department of Health and Human Services as described in paragraph (d)(1)(ii) of this section and does not have an objection as described in § 147.132 to providing the contraceptive services identified in the self-certification or the notification from the Department of Health and Human Services, then the issuer will provide payments for 

contraceptive services as follows— 

(i)  The issuer must expressly exclude contraceptive coverage from the group health insurance coverage provided in connection with the group health plan and provide separate payments for any contraceptive services required to be covered under § 141.130(a)(1)(iv) for plan participants and beneficiaries for so long as they remain enrolled in the plan. 

            (ii)  With respect to payments for contraceptive services, the issuer may not impose any cost-sharing requirements (such as a copayment, coinsurance, or a deductible), premium, fee, or other charge, or any portion thereof, directly or indirectly, on the eligible organization, the group health plan, or plan participants or beneficiaries.  The issuer must segregate premium revenue  

   

collected from the eligible organization from the monies used to provide payments for contraceptive services.  The issuer must provide payments for contraceptive services in a manner that is consistent with the requirements under sections 2706, 2709, 2711, 2713, 2719, and 2719A 

of the PHS Act.  If the group health plan of the eligible organization provides coverage for some but not all of any contraceptive services required to be covered under § 147.130(a)(1)(iv), the issuer is required to provide payments only for those contraceptive services for which the group health plan does not provide coverage.  However, the issuer may provide payments for all contraceptive services, at the issuer’s option. 

(3)  A health insurance issuer may not require any documentation other than a copy of the self-certification from the eligible organization or the notification from the Department of Health and Human Services described in paragraph (d)(1)(ii) of this section.   

(e)  Notice of availability of separate payments for contraceptive services - insured group health plans and student health insurance coverage.  For each plan year to which the optional accommodation in paragraph (d) of this section is to apply, an issuer required to provide payments for contraceptive services pursuant to paragraph (d) of this section must provide to plan participants and beneficiaries written notice of the availability of separate payments for contraceptive services contemporaneous with (to the extent possible), but separate from, any application materials distributed in connection with enrollment (or re-enrollment) in group health coverage that is effective beginning on the first day of each applicable plan year.  The notice 

must specify that the eligible organization does not administer or fund contraceptive benefits, but that the issuer provides separate payments for contraceptive services, and must provide contact information for questions and complaints.  The following model language, or substantially similar language, may be used to satisfy the notice requirement of this paragraph (e) “Your  

[employer/institution of higher education] has certified that your [group health plan/student health insurance coverage] qualifies for an accommodation with respect to the Federal requirement to cover all Food and Drug Administration-approved contraceptive services for women, as prescribed by a health care provider, without cost sharing.  This means that your [employer/institution of higher education] will not contract, arrange, pay, or refer for contraceptive coverage.  Instead, [name of health insurance issuer] will provide separate payments for contraceptive services that you use, without cost sharing and at no other cost, for so long as you are enrolled in your [group health plan/student health insurance coverage].  Your [employer/institution of higher education] will not administer or fund these payments . If you have any questions about this notice, contact [contact information for health insurance issuer].” 

(f)  Definition.  For the purposes of this section, reference to “contraceptive” services, benefits, or coverage includes contraceptive or sterilization items, procedures, or services, or related patient education or counseling, to the extent specified for purposes of § 147.130(a)(1)(iv). 

(g)  Severability.  Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, shall be construed so as to continue to give maximum effect to the provision permitted by law, unless such holding shall be one of utter invalidity or unenforceability, in which event the provision shall be severable from this section and shall not affect the remainder thereof or the application of the provision to persons not similarly situated or to dissimilar circumstances. 

12.  Add § 147.132 to read as follows: 

§ 147.132 Religious exemptions in connection with coverage of certain preventive health 

services. 

(a)  Objecting entities. (1)  Guidelines issued under § 147.130(a)(1)(iv) by the Health Resources and Services Administration must not provide for or support the requirement of coverage or payments for contraceptive services with respect to a group health plan established or maintained by an objecting organization, or health insurance coverage offered or arranged by an objecting organization, and thus the Health Resources and Service Administration will exempt from any guidelines’ requirements that relate to the provision of contraceptive services: 

(i)  A group health plan and health insurance coverage provided in connection with a group health plan to the extent the non-governmental plan sponsor objects as specified in paragraph (a)(2) of this section.  Such non-governmental plan sponsors include, but are not limited to, the following entities-- 

(A)  A church, an integrated auxiliary of a church, a convention or association of 

churches, or a religious order.  

(B)  A nonprofit organization. 

(C)  A closely held for-profit entity.   

(D)  A for-profit entity that is not closely held. 

(E)  Any other non-governmental employer. 

(ii)  An institution of higher education as defined in 20 U.S.C. 1002 in its arrangement of student health insurance coverage, to the extent that institution objects as specified in paragraph (a)(2) of this section.  In the case of student health insurance coverage, this section is applicable in a manner comparable to its applicability to group health insurance coverage provided in connection with a group health plan established or maintained by a plan sponsor that is an employer, and references to “plan participants and beneficiaries” will be interpreted as references 

to student enrollees and their covered dependents; and  

(iii)  A health insurance issuer offering group or individual insurance coverage to the extent the issuer objects as specified in paragraph (a)(2) of this section.  Where a health insurance issuer providing group health insurance coverage is exempt under this paragraph 

(a)(1)(iii), the plan remains subject to any requirement to provide coverage for contraceptive services under Guidelines issued under § 147.130(a)(1)(iv) unless it is also exempt from that requirement.  

(2)  The exemption of this paragraph (a) will apply to the extent that an entity described in paragraph (a)(1) of this section objects to its establishing, maintaining, providing, offering, or arranging (as applicable) coverage, payments, or a plan that provides coverage or payments for some or all contraceptive services, based on its sincerely held religious beliefs. 

(b)  Objecting individuals.  Guidelines issued under § 147.130(a)(1)(iv) by the Health Resources and Services Administration must not provide for or support the requirement of coverage or payments for contraceptive services with respect to individuals who object as specified in this paragraph (b), and nothing in § 147.130(a)(1)(iv), 26 CFR 54.9815–2713(a)(1)(iv), or 29 CFR 2590.715-2713(a)(1)(iv) may be construed to prevent a willing health 

insurance issuer offering group or individual health insurance coverage, and as applicable, a willing plan sponsor of a group health plan, from offering a separate benefit package option, or a separate policy, certificate or contract of insurance, to any individual who objects to coverage or payments for some or all contraceptive services based on sincerely held religious beliefs. 

(c)  Definition.  For the purposes of this section, reference to “contraceptive” services, benefits, or coverage includes contraceptive or sterilization items, procedures, or services, or related patient education or counseling, to the extent specified for purposes of § 147.130(a)(1)(iv).  

(d)  Severability.  Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, shall be construed so as to continue to give maximum effect to the provision permitted by law, unless such holding shall be one of utter invalidity or unenforceability, in which event the provision shall be severable from this section and shall not affect the remainder thereof or the application of the provision to persons not similarly situated or to dissimilar circumstances. 

[Billing Codes: 4830-01-P; 4510-029-P; 4120-01-P; 6325-64] 

[FR Doc. 2017-21851 Filed: 10/6/2017 11:15 am; Publication Date:  10/13/2017]