Contraceptive Coverage

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.

• Preventive Services Contraceptive Zero Copay Exception criteria is intended to allow the member to receive a $0 member cost share for any Health Care Reform preventive services contraceptive product not already covered at a $0 member cost share when determined to be medically necessary. To request the exception your provider should contact CVS directly via phone or fax the Exception Request Form.
• Reimbursement for over-the-counter contraceptives can be submitted by following the instructions on the Prescription Reimbursement Claim Form found here.
• Your plan offers some type of voluntary female sterilization surgery coverage at no cost to members. The contraceptive benefit includes at least one option in each of the HRSA-supported categories of contraception (as well as the screening, education, counseling, and follow-up care). Any type of voluntary female sterilization surgery that is not already available without cost sharing can be accessed through the contraceptive exceptions process described below.
• Your provider can request authorization for voluntary female sterilization surgery that is not already available without cost sharing by completing the Precertification Request for Authorization of Services form. Urgent requests will be reviewed within 24 hours.

FEHBP Members can find additional information regarding their contraception coverage on OPM’s webpage Contraception Coverage (opm.gov). Members can also contact OPM at contraception@opm.gov if they have difficulty accessing contraceptive coverage or other reproductive healthcare.