FAQs on Coverage of Abortion for which Public Funding is Prohibited by Qualified Health Plan (QHP) Issuers in the Individual Market
Guidance for Qualified Health Plan (QHP) issuers in the individual market regarding coverage, segregation of funds, and cost-sharing for abortion services for which public funding is prohibited, including reference to statutory and regulatory requirements (ACA Section 1303 and 45 CFR 156.280).
No material changes — federal guidance reiterates existing segregation and coverage rules after Dobbs.
Policy overview and scope
Post-Dobbs guidance reiterates that federal regulations governing Qualified Health Plan (QHP) issuers' handling of abortion services for which public funding is prohibited remain unchanged: issuers may offer coverage consistent with state law but must follow existing statutory and regulatory requirements. The relevant authorities cited are ACA Section 1303 and 45 CFR 156.280.
QHP issuers that offer coverage of abortions for which federal funding is prohibited are required to segregate funds for those services. Under Section 1303, issuers must segregate a minimum $1 per member per month (PMPM) premium into a separate account that consists solely of such payments and is used exclusively to pay for those abortions.
Offering abortion coverage without cost sharing or as a pre-deductible benefit is permitted where consistent with state law, and issuers may use accumulated segregated funds to provide more comprehensive coverage. However, if a QHP covers a service without cost sharing or as pre-deductible in a manner not permitted under IRC section 223(c)(2), the plan cannot qualify as a high deductible health plan (HDHP), which would affect enrollee Health Savings Account (HSA) eligibility.
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