51092 Federal Register / Vol. 79, No. 166 / Wednesday, August 27, 2014 / Rules and Regulations 

DEPARTMENT OF THE TREASURY 

Internal Revenue Service 

26 CFR Part 54 

[TD–9690] 

RIN 1545–BM38 

DEPARTMENT OF LABOR 

Employee Benefits Security 

Administration 

29 CFR Parts 2510 and 2590 

RIN 1210–AB67 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

45 CFR Parts 147 

[CMS–9939–IFC] 

RIN 0938–AR42 

Coverage of Certain Preventive 

Services Under the Affordable Care 

Act 

AGENCY: Internal Revenue Service, 

Department of the Treasury; Employee 

Benefits Security Administration, 

Department of Labor; Centers for 

Medicare & Medicaid Services, 

Department of Health and Human 

Services. 

ACTION: Interim final rules. 

SUMMARY: This document contains 

interim final regulations regarding 

coverage of certain preventive services 

under section 2713 of the Public Health 

Service Act (PHS Act), added by the 

Patient Protection and Affordable Care 

Act, as amended, and incorporated into 

the Employee Retirement Income 

Security Act of 1974 and the Internal 

Revenue Code. Section 2713 of the PHS 

Act requires coverage without cost 

sharing of certain preventive health 

services by non-grandfathered group 

health plans and health insurance 

coverage. Among these services are 

women’s preventive health services, as 

specified in guidelines supported by the 

Health Resources and Services 

Administration (HRSA). As authorized 

by the current regulations, and 

consistent with the HRSA Guidelines, 

group health plans established or 

maintained by certain religious 

employers (and group health insurance 

coverage provided in connection with 

such plans) are exempt from the 

otherwise applicable requirement to 

cover certain contraceptive services. 

Additionally, under current regulations, 

accommodations are available with 

respect to the contraceptive coverage 

requirement for group health plans 

established or maintained by eligible 

organizations (and group health 

insurance coverage provided in 

connection with such plans), and 

student health insurance coverage 

arranged by eligible organizations that 

are institutions of higher education, that 

effectively exempt them from this 

requirement. The regulations establish a 

mechanism for separately furnishing 

payments for contraceptive services on 

behalf of participants and beneficiaries 

of the group health plans of eligible 

organizations that avail themselves of an 

accommodation, and enrollees and 

dependents of student health coverage 

arranged by eligible organizations that 

are institutions of higher education that 

avail themselves of an accommodation. 

These interim final regulations augment 

current regulations in light of the 

Supreme Court’s interim order in 

connection with an application for an 

injunction in Wheaton College v. 

Burwell, 134 S. Ct. 2806 (2014) 

(Wheaton order). These interim final 

regulations provide an alternative 

process that an eligible organization 

may use to provide notice of its 

religious objections to providing 

contraceptive coverage, while 

preserving participants’ and 

beneficiaries’ (and enrollees’ and 

dependents’) access to coverage for the 

full range of Food and Drug 

Administration (FDA)-approved 

contraceptives, as prescribed by a health 

care provider, without cost sharing. 

DATES: Effective date: These interim 

final regulations are effective on August 

27, 2014. 

Comments: Written comments on 

these interim final regulations are 

invited and must be received by October 

27, 2014. 

ADDRESSES: Written comments may be 

submitted to the Department of Labor as 

specified below. Any comment that is 

submitted will be shared with the 

Department of Health and Human 

Services and the Department of the 

Treasury, and will also be made 

available to the public. Warning: Do not 

include any personally identifiable 

information (such as name, address, or 

other contact information) or 

confidential business information that 

you do not want publicly disclosed. All 

comments may be posted on the Internet 

and can be retrieved by most Internet 

search engines. No deletions, 

modifications, or redactions will be 

made to the comments received, as they 

are public records. Comments may be 

submitted anonymously. 

Comments, identified by ‘‘Preventive 

Services,’’ may be submitted by one of 

the following methods: 

Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

Mail or Hand Delivery: Office of 

Health Plan Standards and Compliance 

Assistance, Employee Benefits Security 

Administration, Room N–5653, U.S. 

Department of Labor, 200 Constitution 

Avenue NW., Washington, DC 20210, 

Attention: Preventive Services. 

Comments received will be posted 

without change to www.regulations.gov 

and available for public inspection at 

the Public Disclosure Room, N–1513, 

Employee Benefits Security 

Administration, 200 Constitution 

Avenue NW., Washington, DC 20210, 

including any personal information 

provided. 

FOR FURTHER INFORMATION CONTACT: 

David Mlawsky, Centers for Medicare & 

Medicaid Services (CMS), Department 

of Health and Human Services (HHS), at 

(410) 786–1565; Amy Turner or Beth 

Baum, Employee Benefits Security 

Administration (EBSA), Department of 

Labor, at (202) 693–8335; Karen Levin, 

Internal Revenue Service (IRS), 

Department of the Treasury, at (202) 

927–9639. 

Customer Service Information: 

Individuals interested in obtaining 

information from the Department of 

Labor concerning employment-based 

health coverage laws may call the EBSA 

Toll-Free Hotline at 1–866–444–EBSA 

(3272) or visit the Department of Labor’s 

Web site (www.dol.gov/ebsa). 

Information from HHS on private health 

insurance coverage can be found on 

CMS’s Web site (www.cms.gov/cciio), 

and information on health care reform 

can be found at www.HealthCare.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background 

The Patient Protection and Affordable 

Care Act (Pub. L. 111–148) was enacted 

on March 23, 2010. The Health Care and 

Education Reconciliation Act of 2010 

(Pub. L. 111–152) was enacted on March 

30, 2010. These statutes are collectively 

known as the Affordable Care Act. The 

Affordable Care Act reorganizes, 

amends, and adds to the provisions of 

part A of title XXVII of the Public 

Health Service Act (PHS Act) relating to 

group health plans and health insurance 

issuers in the group and individual 

markets. The Affordable Care Act adds 

section 715(a)(1) to the Employee 

Retirement Income Security Act of 1974 

(ERISA) and section 9815(a)(1) to the 

Internal Revenue Code (Code) to 

incorporate the provisions of part A of 

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Federal Register / Vol. 79, No. 166 / Wednesday, August 27, 2014 / Rules and Regulations 51093 

1The HRSA Guidelines exclude services relating 

to a man’s reproductive capacity, such as 

vasectomies and condoms. 

2 Interim final regulations published by the 

Departments on July 19, 2010, generally provide 

that plans and issuers must cover a newly 

recommended preventive service starting with the 

first plan year (or, in the individual market, policy 

year) that begins on or after the date that is one year 

after the date on which the new recommendation 

is issued. 26 CFR 54.9815–2713T(b)(1); 29 CFR 

2590.715–2713(b)(1); 45 CFR 147.130(b)(1). 

3The 2011 amended interim final regulations 

were issued and effective on August 1, 2011, and 

published in the Federal Register on August 3, 

2011 (76 FR 46621). 

4HRSA subsequently amended the HRSA 

Guidelines to reflect the simplified definition of 

‘‘religious employer’’ contained in the July 2013 

final regulations, 78 FR 39870 (July 2, 2013) 

(discussed below), effective August 1, 2013. 

5The 2012 final regulations were published in the 

Federal Register on February 15, 2012 (77 FR 8725). 

6 Guidance on the Temporary Enforcement Safe 

Harbor for Certain Employers, Group Health Plans, 

and Group Health Insurance Issuers with Respect to 

the Requirement to Cover Contraceptive Services 

Without Cost Sharing Under Section 2713 of the 

Public Health Service Act, Section 715(a)(1) of the 

Employee Retirement Income Security Act, and 

Section 9815(a)(1) of the Internal Revenue Code; 

originally issued on February 10, 2012, and 

reissued on August 15, 2012 and June 28, 2013; 

available at: http://www.cms.gov/CCIIO/Resources/ 

Regulations-and-Guidance/Downloads/preventiveservices-guidance-6-28-2013.pdf. The guidance 

clarified, among other things, that plans that took 

some action before February 10, 2012, to try, 

without success, to exclude or limit contraceptive 

coverage were not precluded from eligibility for the 

safe harbor. The temporary enforcement safe harbor 

was also available to student health insurance 

coverage arranged by nonprofit institutions of 

higher education with religious objections to 

contraceptive coverage that met the conditions set 

forth in the guidance. See Student Health Insurance 

Coverage, 77 FR 16457 (Mar. 21, 2012). 

title XXVII of the PHS Act into ERISA 

and the Code, and to make them 

applicable to group health plans and 

health insurance issuers providing 

health insurance coverage in connection 

with group health plans. The sections of 

the PHS Act incorporated into ERISA 

and the Code are sections 2701 through 

2728. 

Section 2713 of the PHS Act, as added 

by the Affordable Care Act and 

incorporated into ERISA and the Code, 

requires that non-grandfathered group 

health plans and health insurance 

issuers offering non-grandfathered 

group or individual health insurance 

coverage provide coverage of certain 

specified preventive services without 

cost sharing, including under paragraph 

(a)(4), benefits for certain women’s 

preventive health services as provided 

for in comprehensive guidelines 

supported by the Health Resources and 

Services Administration (HRSA). On 

August 1, 2011, HRSA adopted and 

released guidelines for women’s 

preventive health services (HRSA 

Guidelines) based on recommendations 

of the independent Institute of 

Medicine. As relevant here, the HRSA 

Guidelines include all Food and Drug 

Administration (FDA)-approved 

contraceptives, sterilization procedures, 

and patient education and counseling 

for women with reproductive capacity, 

as prescribed by a health care provider 

(collectively, contraceptive services).1

Except as discussed later in this section, 

non-grandfathered group health plans 

and health insurance coverage are 

required to provide coverage consistent 

with the HRSA Guidelines without cost 

sharing for plan years (or, in the 

individual market, policy years) 

beginning on or after August 1, 2012.2

Interim final regulations 

implementing section 2713 of the PHS 

Act were published on July 19, 2010 (75 

FR 41726) (2010 interim final 

regulations). On August 1, 2011, the 

Departments of Health and Human 

Services (HHS), Labor, and the Treasury 

(collectively, the Departments) amended 

the 2010 interim final regulations to 

provide HRSA with authority to exempt 

group health plans established or 

maintained by certain religious 

employers (and group health insurance 

coverage provided in connection with 

such plans) from the requirement to 

cover contraceptive services consistent 

with the HRSA Guidelines (76 FR 

46621) (2011 amended interim final 

regulations).3 On the same date, HRSA 

exercised this authority in the HRSA 

Guidelines to exempt group health 

plans established or maintained by 

these religious employers (and group 

health insurance coverage provided in 

connection with such plans) from the 

HRSA Guidelines with respect to 

contraceptive services.4 The 2011 

amended interim final regulations 

specified that, for purposes of this 

exemption, a religious employer was 

one that: (1) Has the inculcation of 

religious values as its purpose; (2) 

primarily employs persons who share 

its religious tenets; (3) primarily serves 

persons who share its religious tenets; 

and (4) is a nonprofit organization 

described in section 6033(a)(1) and 

(a)(3)(A)(i) or (iii) of the Code. Section 

6033(a)(3)(A)(i) and (iii) of the Code 

refers to churches, their integrated 

auxiliaries, and conventions or 

associations of churches, as well as to 

the exclusively religious activities of 

any religious order. Final regulations 

issued on February 10, 2012, adopted 

the definition of religious employer in 

the 2011 amended interim final 

regulations without modification (2012 

final regulations).5

Contemporaneous with the issuance 

of the 2012 final regulations, HHS, with 

the agreement of the Departments of 

Labor and the Treasury, issued guidance 

establishing a temporary safe harbor 

from enforcement of the contraceptive 

coverage requirement by the 

Departments for group health plans 

established or maintained by certain 

nonprofit organizations with religious 

objections to contraceptive coverage 

(and group health insurance coverage 

provided in connection with such 

plans).6 The guidance provided that the 

temporary enforcement safe harbor 

would remain in effect until the first 

plan year beginning on or after August 

1, 2013. At the same time, the 

Departments committed to rulemaking 

to achieve the goals of providing 

coverage of recommended preventive 

services, including contraceptive 

services, without cost sharing, while 

simultaneously ensuring that certain 

additional nonprofit organizations with 

religious objections to contraceptive 

coverage would not have to contract, 

arrange, pay, or refer for such coverage. 

On March 21, 2012, the Departments 

published an advance notice of 

proposed rulemaking (ANPRM) that 

described and solicited comments on 

possible approaches to achieve these 

goals (77 FR 16501). 

On February 6, 2013, following 

review of the comments on the ANPRM, 

the Departments published proposed 

regulations at 78 FR 8456 (proposed 

regulations). The regulations proposed 

to simplify and clarify the definition of 

‘‘religious employer’’ for purposes of the 

religious employer exemption. The 

regulations also proposed 

accommodations for group health plans 

established or maintained or arranged 

by certain nonprofit religious 

organizations with religious objections 

to contraceptive coverage (and group 

health insurance coverage provided in 

connection with such plans). These 

organizations were referred to as 

‘‘eligible organizations.’’ 

The regulations proposed that, in the 

case of an insured group health plan 

established or maintained by an eligible 

organization, the health insurance issuer 

providing group health insurance 

coverage in connection with the plan 

would be required to assume sole 

responsibility for providing 

contraceptive coverage to plan 

participants and beneficiaries without 

cost sharing, premium, fee, or other 

charge to plan participants or 

beneficiaries or to the eligible 

organization or its plan. The 

Departments proposed a comparable 

accommodation with respect to student 

health insurance coverage arranged by 

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51094 Federal Register / Vol. 79, No. 166 / Wednesday, August 27, 2014 / Rules and Regulations 

7The EBSA Form 700 is available at: http://www.

dol.gov/ebsa/pdf/preventiveserviceseligible

organizationcertificationform.pdf. When using the 

EBSA 700, the self-certification form is provided 

directly to each third party administrator or issuer 

of the plan. 

eligible organizations that are 

institutions of higher education. 

In the case of a self-insured group 

health plan established or maintained 

by an eligible organization, the 

proposed regulations presented 

potential approaches under which the 

third party administrator of the plan 

would provide or arrange for a third 

party to provide contraceptive coverage 

to plan participants and beneficiaries 

without cost sharing, premium, fee, or 

other charge to plan participants or 

beneficiaries or to the eligible 

organization or its plan. An issuer (or its 

affiliate) would be able to offset the 

costs incurred by the third party 

administrator and the issuer in the 

course of arranging and providing such 

coverage by claiming an adjustment in 

the Federally-facilitated Exchange (FFE) 

user fee. 

The Departments received over 

400,000 comments (many of them 

standardized form letters) in response to 

the proposed regulations. After 

consideration of the comments, the 

Departments published final regulations 

on July 2, 2013 at 78 FR 39870 (July 

2013 final regulations). The July 2013 

final regulations simplified and clarified 

the definition of religious employer for 

purposes of the religious employer 

exemption and established 

accommodations for health coverage 

established or maintained or arranged 

by eligible organizations. A 

contemporaneously re-issued HHS 

guidance document extended the 

temporary safe harbor from enforcement 

of the contraceptive coverage 

requirement by the Departments to 

encompass plan years beginning on or 

after August 1, 2013, and before January 

1, 2014. This guidance included a form 

to be used by an organization during 

this temporary period to self-certify that 

its plan qualified for the temporary 

enforcement safe harbor. In addition, 

HHS and the Department of Labor (DOL) 

issued a self-certification form, EBSA 

Form 700, to be executed by an 

organization seeking to be treated as an 

eligible organization for purposes of an 

accommodation under the July 2013 

final regulations. This self-certification 

form was provided for use with the 

accommodation under the July 2013 

final regulations, after the expiration of 

the temporary enforcement safe harbor 

(that is, for plan years beginning on or 

after January 1, 2014). 

On June 30, 2014, the Supreme Court 

ruled in the case of Burwell v. Hobby 

Lobby Stores, Inc., 134 S. Ct. 2751 

(2014), that, under the Religious 

Freedom Restoration Act of 1993 

(RFRA), the requirement to provide 

contraceptive coverage could not be 

applied to the closely held for-profit 

corporations before the Court because 

their owners had religious objections to 

providing such coverage, and because 

the Government’s goal of guaranteeing 

coverage for contraceptive methods 

without cost sharing could be achieved 

in a less restrictive manner by offering 

such closely held for-profit entities the 

accommodation the Government already 

provided to religious nonprofit 

organizations with religious objections 

to contraceptive coverage. After 

describing this accommodation, the 

Court concluded that the 

accommodation ‘‘does not impinge on 

the plaintiffs’ religious belief that 

providing insurance coverage for the 

contraceptives at issue here violates 

their religion, and it serves HHS’ stated 

interests equally well.’’ 134 S. Ct. at 

2782. The Departments are publishing 

elsewhere in this edition of the Federal 

Register a notice of proposed 

rulemaking (NPRM) that proposes 

possible amendments to the definition 

of the term ‘‘eligible organization’’ to 

include closely held for-profit entities 

with religious objections to 

contraceptive coverage, in light of the 

Hobby Lobby decision. 

On July 3, 2014, the Supreme Court 

issued an interim order in connection 

with an application for an injunction 

pending appeal in Wheaton College v. 

Burwell, 134 S. Ct. 2806 (2014), in 

which the plaintiff challenged under 

RFRA the requirement in the July 2013 

final regulations that an eligible 

organization invoking the 

accommodation send EBSA Form 700 to 

the insurance issuer or third party 

administrator. The Court’s order stated 

that, ‘‘[i]f the [plaintiff] informs the 

Secretary of Health and Human Services 

in writing that it is a nonprofit 

organization that holds itself out as 

religious and has religious objections to 

providing coverage for contraceptive 

services, the [Departments of Labor, 

Health and Human Services, and the 

Treasury] are enjoined from enforcing 

against the [plaintiff]’’ certain 

provisions of the Affordable Care Act 

and related regulations requiring 

coverage without cost sharing of certain 

contraceptive services ‘‘pending final 

disposition of appellate review.’’ 134 

S.Ct. at 2807. The order stated that 

Wheaton College need not use EBSA 

Form 700 or send a copy of the executed 

form to its health insurance issuers or 

third party administrators to meet the 

condition for this injunctive relief. Id. 

The Court also stated that its interim 

order neither affected ‘‘the ability of the 

[plaintiff’s] employees and students to 

obtain, without cost, the full range of 

FDA approved contraceptives,’’ nor 

precluded the Government from relying 

on the notice by the plaintiff ‘‘to 

facilitate the provision of full 

contraceptive coverage under the Act.’’ 

Id. The Court’s order further stated that 

it ‘‘should not be construed as an 

expression of the Court’s views on the 

merits’’ of the plaintiff’s challenge to the 

accommodations. Id. 

The Departments are issuing these 

interim final regulations in light of the 

Supreme Court’s interim order in 

Wheaton concerning notice to the 

Federal government that an eligible 

organization has a religious objection to 

providing contraceptive coverage, as an 

alternative to the EBSA Form 700 

method of self-certification, and to 

preserve participants’ and beneficiaries’ 

(and, in the case of student health 

insurance coverage, enrollees’ and 

dependents’) access to coverage for the 

full range of FDA-approved 

contraceptives, as prescribed by a health 

care provider, without cost sharing. 

II. Overview of the Interim Final 

Regulations 

These interim final regulations amend 

the Departments’ July 2013 final 

regulations to provide an alternative 

process for the sponsor of a group health 

plan or an institution of higher 

education to provide notice of its 

religious objection to coverage of all or 

a subset of contraceptive services, as an 

alternative to the EBSA Form 700 

method of self-certification. These 

interim final regulations continue to 

allow eligible organizations to use EBSA 

Form 700, as set forth in the July 2013 

final regulations and guidance.7

The alternative process permitted by 

these interim final regulations is 

consistent with the Wheaton order. It 

provides that an eligible organization 

may notify HHS in writing of its 

religious objection to coverage of all or 

a subset of contraceptive services. The 

notice must include the name of the 

eligible organization and the basis on 

which it qualifies for an 

accommodation; its objection based on 

sincerely held religious beliefs to 

providing 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); the plan name 

and type (i.e., whether it is a student 

health insurance plan within the 

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Federal Register / Vol. 79, No. 166 / Wednesday, August 27, 2014 / Rules and Regulations 51095 

8Church plans are exempt from ERISA pursuant 

to ERISA section 4(b)(2). As such, a third party 

administrator of a self-insured church plan cannot 

become the plan administrator by operation of 29 

CFR 2510.3–16, although such third party 

administrators may voluntarily provide or arrange 

separate payments for contraceptive services and 

seek reimbursement for associated expenses under 

the process set forth in 45 CFR 156.50. 

meaning of 45 CFR 147.145(a) or a 

church plan within the meaning of 

ERISA section 3(33)); and the name and 

contact information for any of the plan’s 

third party administrators and health 

insurance issuers.8 A model notice to 

HHS that eligible organizations may, but 

are not required to, use is available at: 

http://www.cms.gov/cciio/resources/

Regulations-and-Guidance/index.html#

Prevention. If there is a change in any 

of the information required to be 

included in the notice, the organization 

must provide updated information to 

HHS. 

As with the process established in the 

July 2013 final regulations, nothing in 

this alternative notice process requires a 

government assessment of the sincerity 

of the religious belief underlying the 

eligible organization’s objection. The 

notice to HHS, and any subsequent 

updates, should be sent electronically 

to: marketreform@cms.hhs.gov, or by 

regular mail to: Centers for Medicare & 

Medicaid Services, Center for Consumer 

Information and Insurance Oversight, 

200 Independence Avenue SW., 

Washington, DC 20201, Room 739H. 

The content required for the notice 

represents the minimum information 

necessary for the Departments to 

determine which entities are covered by 

the accommodation, to administer the 

accommodation, and to implement the 

policies in the July 2013 final 

regulations. 

When an eligible organization that 

establishes or maintains or arranges a 

self-insured plan subject to ERISA 

provides such a notice to HHS, DOL 

(working with HHS) will send a separate 

notification to each third party 

administrator of the ERISA plan. DOL’s 

notification will inform each third party 

administrator of the eligible 

organization’s religious objection to 

funding or administering some or all 

contraceptive coverage and will 

designate the relevant third party 

administrator(s) as plan administrator 

under section 3(16) of ERISA for those 

contraceptive benefits that the third 

party administrator would otherwise 

manage. The DOL notification will be an 

instrument under which the plan is 

operated and shall supersede any earlier 

designation. In establishing and 

implementing this alternative process, 

DOL is exercising its broad rulemaking 

authority under Title I of ERISA, which 

includes the ability to interpret and 

apply the definition of a plan 

administrator under ERISA section 

3(16)(A). 

If an eligible organization that 

establishes or maintains an insured 

health plan provides a notice to HHS 

under this alternative process, HHS will 

send a separate notification to the plan’s 

health insurance issuer(s) informing the 

issuer(s) that HHS has received a notice 

under § 2590.715–2713A(c)(1) and 

describing the obligations of the 

issuer(s) under § 2590.715–2713A. 

Issuers remain responsible for 

compliance with the statutory and 

regulatory requirement to provide 

coverage for contraceptive services to 

participants and beneficiaries, and to 

enrollees and dependents of student 

health plans, notwithstanding that the 

policyholder is an eligible organization 

with a religious objection to 

contraceptive coverage that will not 

have to contract, arrange, pay, or refer 

for such coverage. 

Other questions have arisen regarding 

the requirement to provide coverage for 

contraceptive services without cost 

sharing and the accommodations for 

eligible organizations. In what has been 

described as the ‘‘non-interference 

provision,’’ the July 2013 final 

regulations provided that eligible 

organizations that establish or maintain 

self-insured group health plans ‘‘must 

not, directly or indirectly seek to 

interfere with a third party 

administrator’s arrangements to provide 

or arrange for separate payments for 

contraceptive services’’ and ‘‘must not, 

directly or indirectly, seek to influence 

a third party administrator’s decision to 

make any such arrangements.’’ 26 CFR 

54.9815–2713A(b)(1)(iii); 29 CFR 

2590.715–2713A(b)(1)(iii). The 

Departments interpret the July 2013 

final regulations solely as prohibiting 

the use of bribery, threats, or other 

forms of economic coercion in an 

attempt to prevent a third party 

administrator from fulfilling its 

independent legal obligations to provide 

or arrange separate payments for 

contraceptive services. Because such 

conduct is generally unlawful and is 

prohibited under other state and federal 

laws, and to reduce unnecessary 

confusion, these interim final 

regulations delete the language 

prohibiting an eligible organization from 

interfering with or seeking to influence 

a third party administrator’s decision or 

efforts to provide separate payments for 

contraceptive services. 

III. Interim Final Regulations and 

Request for Comments 

Section 9833 of the Code, section 734 

of ERISA, and section 2792 of the PHS 

Act authorize the Secretaries of the 

Treasury, Labor, and HHS (collectively, 

the Secretaries) to promulgate any 

interim final rules that they determine 

are appropriate to carry out the 

provisions of chapter 100 of the Code, 

part 7 of subtitle B of title I of ERISA, 

and part A of title XXVII of the PHS Act, 

which include PHS Act sections 2701 

through 2728 and the incorporation of 

those sections into ERISA section 715 

and Code section 9815. 

In addition, under Section 553(b) of 

the Administrative Procedure Act (APA) 

(5 U.S.C. 551 et seq.), a general notice 

of proposed rulemaking is not required 

when an agency, for good cause, finds 

that notice and public comment thereon 

are impracticable, unnecessary, or 

contrary to the public interest. The 

provisions of the APA that ordinarily 

require a notice of proposed rulemaking 

do not apply here because of the 

specific authority granted by section 

9833 of the Code, section 734 of ERISA, 

and section 2792 of the PHS Act. 

However, even if these provisions of the 

APA were applicable, the Secretaries 

have determined that it would be 

impracticable and contrary to the public 

interest to delay putting the provisions 

in these interim final regulations in 

place until a full public notice and 

comment process is completed. 

As discussed earlier, the Departments 

are issuing these interim final 

regulations in light of the Supreme 

Court’s order in Wheaton College 

concerning notice to the Federal 

government that an eligible organization 

has a religious objection to providing 

contraceptive coverage, as an alternative 

to the EBSA Form 700, and to preserve 

participants’ and beneficiaries’ (and, in 

the case of student health insurance 

coverage, enrollees’ and dependents’) 

access to coverage for the full range of 

FDA-approved contraceptive services, 

as prescribed by a health care provider, 

without cost sharing. That order was 

issued and was effective on July 3, 2014. 

In order to provide other eligible 

organizations with an option equivalent 

to the one the Supreme Court provided 

to Wheaton College on an interim basis, 

regulations must be published and 

available to the public as soon as 

possible. Delaying the availability of the 

alternative process in order to allow for 

a full notice and comment period would 

delay the ability of eligible 

organizations to avail themselves of this 

alternative process and could delay 

women’s access to contraceptive 

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51096 Federal Register / Vol. 79, No. 166 / Wednesday, August 27, 2014 / Rules and Regulations 

9For purposes of this analysis, the Department 

assumes that the same amount of time will be 

required to prepare the self-certification and the 

notice to HHS. 

coverage without cost sharing, thereby 

compromising their access to necessary 

contraceptive services. Issuing interim 

final regulations provides the public 

with an opportunity to comment on 

whether these regulations affording this 

alternative should be made permanent 

or subject to modification without 

delaying the effective date of the 

regulations. 

For the foregoing reasons, the 

Departments have determined that it 

would be impracticable and contrary to 

the public interest to engage in full 

notice and comment rulemaking before 

putting these interim final regulations 

into effect, and that it is in the public 

interest to promulgate interim final 

regulations. For the same reasons, the 

Departments have determined, 

consistent with section 553(d) of the 

APA (5 U.S.C. 553(d)), that there is good 

cause to make these interim final 

regulations effective immediately upon 

publication in the Federal Register. 

IV. Economic Impact and Paperwork 

Burden 

A. Executive Orders 12866 and 13563— 

Department of Health and Human 

Services and Department of Labor 

Executive Orders 12866 and 13563 

direct agencies to assess all costs and 

benefits of available regulatory 

alternatives and, if regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, and public health and 

safety effects; distributive impacts; and 

equity). Executive Order 13563 

emphasizes the importance of 

quantifying both costs and benefits, 

reducing costs, harmonizing rules, and 

promoting flexibility. 

Section 3(f) of Executive Order 12866 

defines a ‘‘significant regulatory action’’ 

as an action that is likely to result in a 

regulation: (1) Having an annual effect 

on the economy of $100 million or more 

in any one year, or adversely and 

materially affecting a sector of the 

economy, productivity, competition, 

jobs, the environment, public health or 

safety, or state, local, or tribal 

governments or communities (also 

referred to as ‘‘economically 

significant’’); (2) creating a serious 

inconsistency or otherwise interfering 

with an action taken or planned by 

another agency; (3) materially altering 

the budgetary impacts of entitlement 

grants, user fees, or loan programs or the 

rights and obligations of recipients 

thereof; or (4) raising novel legal or 

policy issues arising out of legal 

mandates, the President’s priorities, or 

the principles set forth in the Executive 

Order. 

A regulatory impact analysis must be 

prepared for major rules with 

economically significant effects ($100 

million or more in any one year), and 

an ‘‘economically significant’’ 

regulatory action is subject to review by 

the Office of Management and Budget 

(OMB). These interim final regulations 

are not likely to have economic impacts 

of $100 million or more in any one year, 

and therefore do not meet the definition 

of ‘‘economically significant’’ under 

Executive Order 12866. 

1. Need for Regulatory Action 

These interim final regulations amend 

the Departments’ July 2013 final 

regulations to provide an alternative 

process for an eligible organization to 

provide notice of its religious objection 

to coverage of all or a subset of 

contraceptive services. 

2. Anticipated Effects 

The Departments expect that these 

interim final regulations will not result 

in any additional burden on or costs to 

the affected entities. These interim final 

regulations do not change the 

fundamental ability of an eligible 

organization to exempt itself from 

contracting, arranging, paying, or 

referring for contraceptive coverage. 

Instead, the regulations merely provide 

alternative means for eligible 

organizations to provide notice of their 

religious objection to coverage of all, or 

a subset of, contraceptive services. 

B. Special Analyses—Department of the 

Treasury 

For purposes of the Department of the 

Treasury, it has been determined that 

this rule is not a significant regulatory 

action as defined in Executive Order 

12866, as supplemented by Executive 

Order 13563. Therefore, a regulatory 

assessment is not required. It also has 

been determined that section 553(b) of 

the APA does not apply to these 

regulations. Pursuant to the Regulatory 

Flexibility Act (5 U.S.C. chapter 6), it is 

hereby certified that this rule will not 

have a significant economic impact on 

a substantial number of small entities 

This certification is based on the fact 

that the temporary regulations will not 

result in any additional costs to affected 

entities but will provide an alternative 

means for eligible organizations to 

provide notice of their religious 

objection to providing coverage of all, or 

a subset of, contraceptive services. 

Pursuant to section 7805(f) of the Code, 

these temporary regulations have been 

submitted to the Chief Counsel for 

Advocacy of the Small Business 

Administration for comment on their 

impact on small business. 

C. Paperwork Reduction Act— 

Department of Health and Human 

Services 

Under the Paperwork Reduction Act, 

an agency may not conduct or sponsor, 

and an individual is not required to 

respond to, a collection of information 

unless it displays a valid OMB control 

number. These interim final regulations 

contain an information collection 

request (ICR) that is subject to review by 

the Office of Management and Budget 

(OMB). A description of these 

provisions is given in the following 

section with an estimate of the annual 

burden. Average labor costs (including 

fringe benefits) used to estimate the 

costs are calculated using data available 

from the Bureau of Labor Statistics. 

Each organization seeking to be 

treated as an eligible organization under 

these interim final regulations must 

either use the EBSA Form 700 method 

of self-certification or provide notice to 

HHS of its religious objection to 

coverage of all or a subset of 

contraceptive services. Specifically, 

these interim final regulations continue 

to allow eligible organizations to notify 

an issuer or third party administrator 

using EBSA Form 700, as set forth in the 

July 2013 final regulations. In addition, 

these interim final regulations permit an 

alternative process, consistent with the 

Supreme Court’s interim order in 

Wheaton College, by which an eligible 

organization may notify HHS of its 

religious objection to coverage of all or 

a subset of contraceptive services. HHS 

is aware, based on litigation, that there 

are approximately 122 eligible 

organizations that would now have the 

option to provide notice to HHS, rather 

than provide a self-certification to TPAs 

and/or issuers. 

In order to complete this task, HHS 

assumes that clerical staff for each 

eligible organization will gather and 

enter the necessary information and 

send the self-certification to the issuer 

or third party administrator as 

appropriate, or send the notice to HHS.9

HHS assumes that a compensation and 

benefits manager and inside legal 

counsel will review the self-certification 

or notice to HHS and a senior executive 

would execute it. HHS estimates that an 

eligible organization would spend 

approximately 45 minutes (30 minutes 

of clerical labor at a cost of $30 per 

hour, 10 minutes for a compensation 

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10 In 2014, that threshold level is approximately 

$141 million. 

and benefits manager at a cost of $102 

per hour, 5 minutes for legal counsel at 

a cost of $127, and 5 minutes by a senior 

executive at a cost of $121) preparing 

and sending the self-certification or 

notice to HHS and filing it to meet the 

recordkeeping requirement. Therefore, 

the total annual burden for preparing 

and providing the information in the 

self-certification or notice to HHS will 

require approximately 50 minutes for 

each eligible organization with an 

equivalent cost burden of approximately 

$53 for a total hour burden of 102 hours 

with an equivalent cost of $6,430. 

As the Department of Labor and the 

Department of Health and Human 

Services share jurisdiction they are 

splitting the hour burden so each will 

account for 51 burden hours. HHS 

estimates that each self-certification or 

notice to HHS will require $0.49 in 

postage and $0.05 in materials cost 

(paper and ink) and the total postage 

and materials cost for each selfcertification or notice sent via mail will 

be $0.54. For purposes of this analysis, 

HHS assumes that all self-certifications 

or notices to HHS will be mailed. The 

total cost burden for the selfcertifications or notices to HHS is 

approximately $66. 

As the Department of Labor and the 

Department of Health and Human 

Services share jurisdiction they are 

splitting the cost burden so each will 

account for $33 of the cost burden. 

D. Paperwork Reduction Act— 

Department of Labor and Department of 

the Treasury 

Under the Paperwork Reduction Act, 

an agency may not conduct or sponsor, 

and an individual is not required to 

respond to, a collection of information 

unless it displays a valid OMB control 

number. In accordance with the 

requirements of the PRA, the EBSA 

Form 700 ICR has been approved by 

OMB under control number 1210–0150. 

These interim final regulations amend 

the ICR by providing an alternative 

process consistent with the Wheaton 

order, as discussed earlier in this 

preamble. The Department of Labor 

submitted an ICR in order to obtain 

OMB approval under the PRA for the 

regulatory revision. The request was 

made under emergency clearance 

procedures specified in regulations at 5 

CFR 1320.13. In response, OMB 

approved the ICR under control number 

1210–0150 through January 31, 2015. A 

copy of the information collection 

request may be obtained free of charge 

on the RegInfo.gov Web site at http://

www.reginfo.gov/public/do/PRA

ViewICR?ref_nbr=201408-1210-001. 

This approval allows respondents 

temporarily to utilize the additional 

flexibility these final regulations 

provide, while the Department seeks 

public comment on the collection 

methods—including their utility and 

burden. Contemporaneously with the 

publication of these interim final 

regulations, the Department of Labor 

published a notice elsewhere in today’s 

issue of the Federal Register informing 

the public of their intention to extend 

the OMB approval. 

Consistent with the analysis in the 

HHS PRA section above the Department 

expects that each of the estimated 122 

organizations will spend approximately 

50 minutes in preparation time and 

incur $0.54 mailing cost to satisfy the 

requirements. The DOL information 

collections in this rule are found in 29 

CFR 2510.3–16 and 2590.715–2713A 

and are summarized as follows: 

Type of Review: Revised Collection. 

Agency: DOL–EBSA. 

Title: Coverage of Certain Preventive 

Services Under the Affordable Care Act. 

OMB Numbers: 1210–0150. 

Affected Public: Private Sector— 

businesses or other for profits. 

Total Respondents: 61 (combined 

with HHS total is 122). 

Total Responses: 61 (combined with 

HHS total is 122). 

Frequency of Response: On occasion. 

Estimated Total Annual Burden 

Hours: 51 (combined with HHS total is 

102 hours. 

Estimated Total Annual Burden Cost: 

$33 (combined with HHS total is 66). 

E. Regulatory Flexibility Act— 

Department of Labor and Department of 

Health and Human Services 

The Regulatory Flexibility Act (5 

U.S.C. 601 et seq.) (RFA) imposes 

certain requirements with respect to 

Federal rules that are subject to the 

notice and comment requirements of 

section 553(b) of the APA (5 U.S.C. 551 

et seq.) and that are likely to have a 

significant economic impact on a 

substantial number of small entities. 

Under Section 553(b) of the APA, a 

general notice of proposed rulemaking 

is not required when an agency, for 

good cause, finds that notice and public 

comment thereon are impracticable, 

unnecessary, or contrary to the public 

interest. These interim final regulations 

are exempt from APA’s prior notice and 

comment requirement because the 

Departments made a good cause finding 

that a general notice of proposed 

rulemaking is not necessary earlier in 

this preamble. Therefore, the RFA does 

not apply and the Departments are not 

required to either certify that the rule 

would not have a significant economic 

impact on a substantial number of small 

entities or conduct a regulatory 

flexibility analysis. 

Nevertheless, the Departments 

carefully considered the likely impact of 

the rule on small entities in connection 

with their assessment under Executive 

Order 12866. The Departments do not 

expect that these interim final 

regulations will have a significant 

economic effect on a substantial number 

of small entities, because they will not 

result in any additional costs to affected 

entities. Instead, the regulations merely 

provide an alternative means for eligible 

organizations to provide notice of their 

religious objection to coverage of all, or 

a subset of, contraceptive services. 

F. Unfunded Mandates Reform Act 

For purposes of the Unfunded 

Mandates Reform Act of 1995 (Pub. L. 

104–4), as well as Executive Order 

12875, these interim final regulations do 

not include any federal mandate that 

may result in expenditures by state, 

local, or tribal governments, nor do they 

include any federal mandates that may 

impose an annual burden of $100 

million, adjusted for inflation, or more 

on the private sector.10

G. Federalism—Department of Health 

and Human Services and Department of 

Labor 

Executive Order 13132 outlines 

fundamental principles of federalism, 

and requires the adherence to specific 

criteria by federal agencies in the 

process of their formulation and 

implementation of policies that have 

‘‘substantial direct effects’’ on states, the 

relationship between the federal 

government and states, or the 

distribution of power and 

responsibilities among the various 

levels of government. Federal agencies 

promulgating regulations that have 

these federalism implications must 

consult with state and local officials, 

and describe the extent of their 

consultation and the nature of the 

concerns of state and local officials in 

the preamble to the regulation. 

These interim final regulations do not 

have any Federalism implications, since 

they only provide an eligible 

organization with an alternative process 

to provide notice of its religious 

objection to coverage of all or a subset 

of contraceptive services. 

V. Statutory Authority 

The Department of the Treasury 

temporary regulations are adopted 

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51098 Federal Register / Vol. 79, No. 166 / Wednesday, August 27, 2014 / Rules and Regulations 

pursuant to the authority contained in 

sections 7805 and 9833 of the Code. 

The Department of Labor regulations 

are adopted pursuant to the authority 

contained in 29 U.S.C. 1002(16), 1027, 

1059, 1135, 1161–1168, 1169, 1181– 

1183, 1181 note, 1185, 1185a, 1185b, 

1185d, 1191, 1191a, 1191b, and 1191c; 

sec. 101(g), Public Law 104–191, 110 

Stat. 1936; sec. 401(b), Public Law 105– 

200, 112 Stat. 645 (42 U.S.C. 651 note); 

sec. 512(d), Public Law 110–343, 122 

Stat. 3881; sec. 1001, 1201, and 1562(e), 

Public Law 111–148, 124 Stat. 119, as 

amended by Public Law 111–152, 124 

Stat. 1029; Secretary of Labor’s Order 1– 

2011, 77 FR 1088 (Jan. 9, 2012). 

The Department of Health and Human 

Services regulations are adopted 

pursuant to the authority contained in 

sections 2701 through 2763, 2791, and 

2792 of the PHS Act (42 U.S.C. 300gg 

through 300gg–63, 300gg–91, and 

300gg–92), as amended; and Title I of 

the Affordable Care Act, sections 1301– 

1304, 1311–1312, 1321–1322, 1324, 

1334, 1342–1343, 1401–1402, and 1412, 

Pub. L. 111–148, 124 Stat. 119 (42 

U.S.C. 18021–18024, 18031–18032, 

18041–18042, 18044, 18054, 18061, 

18063, 18071, 18082, 26 U.S.C. 36B, and 

31 U.S.C. 9701). 

List of Subjects 

26 CFR Part 54 

Excise taxes, Health care, Health 

insurance, Pensions, Reporting and 

recordkeeping requirements. 

29 CFR Part 2510 

Employee benefit plans, Pensions. 

29 CFR Part 2590 

Continuation coverage, Disclosure, 

Employee benefit plans, Group health 

plans, Health care, Health insurance, 

Medical child support, Reporting and 

recordkeeping requirements. 

45 CFR Part 147 

Health care, Health insurance, 

Reporting and recordkeeping 

requirements, State regulation of health 

insurance. 

Signed this 20th day of August 2014. 

John Dalrymple, 

Deputy Commissioner for Services and 

Enforcement, Internal Revenue Service. 

Mark J. Mazur, 

Assistant Secretary of the Treasury (Tax 

Policy). 

Signed this 20th day of August 2014. 

Phyllis C. Borzi, 

Assistant Secretary, Employee Benefits 

Security Administration, Department of 

Labor. 

Dated: August 19, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: August 20, 2014. 

Sylvia M. Burwell, 

Secretary, Department of Health and Human 

Services. 

DEPARTMENT OF THE TREASURY 

Internal Revenue Service 

Accordingly, 26 CFR part 54 is 

amended as follows: 

PART 54—PENSION EXCISE TAXES 

■ Paragraph 1. The authority citation 

for part 54 continues to read, in part, as 

follows: 

Authority: 26 U.S.C. 7805. * * * 

■ Par. 2. Section 54.9815–2713A is 

amended by revising paragraphs (b), 

(c)(1), and (c)(2)(i) introductory text, and 

adding paragraph (f), to read as follows: 

§ 54.9815–2713A Accommodations in 

connection with coverage of preventive 

health services. 

* * * * * 

(b) [Reserved]. For further guidance, 

see § 54.9815–2713AT(b). 

(c) Contraceptive coverage—insured 

group health plans. (1) [Reserved]. For 

further guidance, see § 54.9815– 

2713AT(c)(1). 

(2) * * * 

(i) [Reserved]. For further guidance, 

see § 54.9815–2713AT(c)(2)(i) 

introductory text. 

* * * * * 

(f) [Reserved]. For further guidance, 

see § 54.9815–2713AT(f). 

■ Par. 3. Section 54.9815–2713AT is 

added to read as follows: 

§ 54.9815–2713AT Accommodations in 

connection with coverage of preventive 

health services (temporary). 

(a) [Reserved]. For further guidance, 

see § 54.9815–2713A(a). 

(b) Contraceptive coverage—selfinsured group health plans. (1) A group 

health plan established or maintained 

by an eligible organization that provides 

benefits on a self-insured basis complies 

for one or more plan years with any 

requirement under § 54.9815– 

2713(a)(1)(iv) to provide contraceptive 

coverage if all of the requirements of 

this paragraph (b)(1) are satisfied: 

(i) The eligible organization or its plan 

contracts with one or more third party 

administrators. 

(ii) The eligible organization provides 

either a copy of the self-certification to 

each third party administrator or a 

notice to the Secretary of Health and 

Human Services that it is an eligible 

organization and of its religious 

objection to coverage of all or a subset 

of contraceptive services. 

(A) When a copy of the selfcertification is provided directly to a 

third party administrator, such selfcertification must include notice that 

obligations of the third party 

administrator are set forth in 29 CFR 

2510.3–16 and this section and under 

§ 54.9815–2713A. 

(B) When a notice is provided to the 

Secretary of Health and Human 

Services, the notice must include the 

name of the eligible organization and 

the basis on which it qualifies for an 

accommodation; its objection based on 

sincerely held religious beliefs 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); the plan name 

and type (i.e., 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 

ERISA section 3(33)); and the name and 

contact information for any of the plan’s 

third party administrators and health 

insurance issuers. If there is a change in 

any of the information required to be 

included in the notice, the organization 

must provide updated information to 

the Secretary of Health and Human 

Services. 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 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 29 CFR 

2510.3–16 and this section and under 

§ 54.9815–2713A. 

(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 agrees to 

enter into or remain in a contractual 

relationship with the eligible 

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Federal Register / Vol. 79, No. 166 / Wednesday, August 27, 2014 / Rules and Regulations 51099 

organization or its plan to provide 

administrative services for the plan, the 

third party administrator shall provide 

or arrange payments for contraceptive 

services using one of the following 

methods— 

(i) Provide payments for contraceptive 

services for plan participants and 

beneficiaries without imposing any costsharing requirements (such as a 

copayment, coinsurance, or a 

deductible), or imposing a 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), or imposing a 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. 

(c) Contraceptive coverage—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 

complies for one or more plan years 

with any requirement under § 54.9815– 

2713(a)(1)(iv) to provide contraceptive 

coverage if the eligible organization or 

group health plan provides either a copy 

of the self-certification to each issuer 

providing coverage in connection with 

the plan or a notice to the Secretary of 

Health and Human Services that it is an 

eligible organization and of its religious 

objection to coverage for all or a subset 

of contraceptive services. 

(i) When a copy of the selfcertification is provided directly to an 

issuer, the issuer has sole responsibility 

for providing such coverage in 

accordance with § 54.9815–2713. An 

issuer may not require any further 

documentation from the eligible 

organization regarding its status as such. 

(ii) When a notice is provided to the 

Secretary of Health and Human 

Services, the notice must include the 

name of the eligible organization and 

the basis on which it qualifies for an 

accommodation; its objection based on 

its sincerely held religious beliefs to 

coverage of some or all contraceptive 

services, as applicable (including an 

identification of the subset of 

contraceptive services to which 

coverage the eligible organization 

objects, if applicable); the plan name 

and type (i.e., 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 

ERISA section 3(33)); and the name and 

contact information for any of the plan’s 

third party administrators and health 

insurance issuers. If there is a change in 

any of the information required to be 

included in the notice, the organization 

must provide updated information to 

the Secretary of Health and Human 

Services. 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)(1) of this section and 

describing the obligations of the issuer 

under this section and under § 54.9815– 

2713A. 

(2) Payments for contraceptive 

services. (i) A group health insurance 

issuer that receives a copy of the selfcertification or notification described in 

paragraph (b)(1)(ii) of this section with 

respect to a group health plan 

established or maintained by an eligible 

organization in connection with which 

the issuer would otherwise provide 

contraceptive coverage under § 54.9815– 

2713(a)(1)(iv) must— 

(ii) [Reserved]. For further guidance, 

see § 54.9815–2713A(c)(2)(ii). 

(d) [Reserved]. For further guidance, 

see § 54.9815–2713A(d). 

(e) [Reserved]. For further guidance, 

see § 54.9815–2713A(e). 

(f) Expiration date. This section 

expires on August 22, 2017 or on such 

earlier date as may be provided in final 

regulations or other action published in 

the Federal Register. 

DEPARTMENT OF LABOR 

Employee Benefits Security 

Administration 

For the reasons stated in the 

preamble, the Department of Labor 

amends 29 CFR parts 2510 and 2590 as 

follows: 

PART 2510—DEFINITION OF TERMS 

USED IN SUBCHAPTERS C, D, E, F, G, 

AND L OF THIS CHAPTER 

■ 4. The authority citation for part 2510 

is revised to read as follows: 

Authority: 29 U.S.C. 1002(2), 1002(16), 

1002(21),1002(37), 1002(38), 1002(40), 1031, 

and 1135; Secretary of Labor’s Order 1–2011, 

77 FR 1088 (Jan. 9, 2012); Sec. 2510.3–101 

also issued under sec. 102 of Reorganization 

Plan No. 4 of 1978, 43 FR 47713, 3 CFR, 1978 

Comp., p. 332 and E.O. 12108, 44 FR 1065, 

3 CFR, 1978 Comp., p. 275, and 29 U.S.C. 

1135 note. Sec. 2510.3–102 also issued under 

sec. 102 of Reorganization Plan No. 4 of 1978, 

43 FR 47713, 3 CFR, 1978 Comp., p. 332 and 

E.O. 12108, 44 FR 1065, 3 CFR, 1978 Comp., 

p. 275. Sec. 2510.3–38 is also issued under 

sec. 1, Pub. L. 105–72, 111 Stat. 1457. 

■ 5. Revise the heading for part 2510 to 

read as set forth above. 

■ 6. Section 2510.3–16 is amended by 

revising paragraph (b) and adding a new 

paragraph (c) to read as follows: 

§ 2510.3–16 Definition of ‘‘plan 

administrator.’’ 

* * * * * 

(b) In the case of a self-insured group 

health plan established or maintained 

by an eligible organization, as defined in 

§ 2590.715–2713A(a) of this chapter, if 

the eligible organization provides a copy 

of the self-certification of its objection to 

administering or funding any 

contraceptive benefits in accordance 

with § 2590.715–2713A(b)(1)(ii) of this 

chapter to a third party administrator, 

the self-certification shall be an 

instrument under which the plan is 

operated, shall be treated as a 

designation of the third party 

administrator as the plan administrator 

under section 3(16) of ERISA for any 

contraceptive services required to be 

covered under § 2590.715–2713(a)(1)(iv) 

of this chapter to which the eligible 

organization objects on religious 

grounds, and shall supersede any earlier 

designation. If, instead, the eligible 

organization notifies the Secretary of 

Health and Human Services of its 

objection to administering or funding 

any contraceptive benefits in 

accordance with § 2590.715– 

2713A(b)(1)(ii) of this chapter, the 

Department of Labor, working with the 

Department of Health and Human 

Services, shall separately provide 

notification to each third party 

administrator that such third party 

administrator shall be the plan 

administrator under section 3(16) of 

ERISA for any contraceptive services 

required to be covered under 

§ 2590.715–2713(a)(1)(iv) of this chapter 

to which the eligible organization 

objects on religious grounds, with 

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51100 Federal Register / Vol. 79, No. 166 / Wednesday, August 27, 2014 / Rules and Regulations 

respect to benefits for contraceptive 

services that the third party 

administrator would otherwise manage. 

Such notification from the Department 

of Labor shall be an instrument under 

which the plan is operated and shall 

supersede any earlier designation. 

(c) A third party administrator that 

becomes a plan administrator pursuant 

to this section shall be responsible for— 

(1) Complying with section 2713 of 

the Public Health Service Act (42 U.S.C. 

300gg–13) (as incorporated into section 

715 of ERISA) and § 2590.715–2713 of 

this chapter with respect to coverage of 

contraceptive services. To the extent the 

plan contracts with different third party 

administrators for different 

classifications of benefits (such as 

prescription drug benefits versus 

inpatient and outpatient benefits), each 

third party administrator is responsible 

for providing contraceptive coverage 

that complies with section 2713 of the 

Public Health Service Act (as 

incorporated into section 715 of ERISA) 

and § 2590.715–2713 of this chapter 

with respect to the classification or 

classifications of benefits subject to its 

contract. 

(2) Establishing and operating a 

procedure for determining such claims 

for contraceptive services in accordance 

with § 2560.503–1 of this chapter. 

(3) Complying with disclosure and 

other requirements applicable to group 

health plans under Title I of ERISA with 

respect to such benefits. 

PART 2590—RULES AND 

REGULATIONS FOR GROUP HEALTH 

PLANS 

■ 7. The authority citation for part 2590 

is revised to read as follows: 

Authority: 29 U.S.C. 1027, 1059, 1135, 

1161–1168, 1169, 1181–1183, 1181 note, 

1185, 1185a, 1185b, 1185d, 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. 

12(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; Secretary of Labor’s 

Order 1–2011, 77 FR 1088 (January 9, 2012). 

■ 8. Section 2590.715–2713A is 

amended by revising paragraphs (b), 

(c)(1), and (c)(2)(i) introductory text to 

read as follows: 

§ 2590.715–2713A Accommodations in 

connection with coverage of preventive 

health services. 

* * * * * 

(b) Contraceptive coverage—selfinsured group health plans—(1) A group 

health plan established or maintained 

by an eligible organization that provides 

benefits on a self-insured basis complies 

for one or more plan years with any 

requirement under § 2590.715– 

2713(a)(1)(iv) to provide contraceptive 

coverage if all of the requirements of 

this paragraph (b)(1) are satisfied: 

(i) The eligible organization or its plan 

contracts with one or more third party 

administrators. 

(ii) The eligible organization provides 

either a copy of the self-certification to 

each third party administrator or a 

notice to the Secretary of Health and 

Human Services that it is an eligible 

organization and of its religious 

objection to coverage of all or a subset 

of contraceptive services. 

(A) When a copy of the selfcertification is provided directly to a 

third party administrator, such selfcertification 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 and 

the basis on which it qualifies for an 

accommodation; its objection based on 

sincerely held religious beliefs 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); the plan name 

and type (i.e., 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 

ERISA section 3(33)); and the name and 

contact information for any of the plan’s 

third party administrators and health 

insurance issuers. If there is a change in 

any of the information required to be 

included in the notice, the organization 

must provide updated information to 

the Secretary of Health and Human 

Services. The Department of Labor 

(working with the Department of Health 

and Human Services), shall send a 

separate notification to each of the 

plan’s third party administrators 

informing the third party administrator 

that the Secretary 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 agrees to 

enter into or remain in a contractual 

relationship with the eligible 

organization or its plan to provide 

administrative services for the plan, the 

third party administrator shall provide 

or arrange payments for contraceptive 

services using one of the following 

methods— 

(i) Provide payments for contraceptive 

services for plan participants and 

beneficiaries without imposing any costsharing requirements (such as a 

copayment, coinsurance, or a 

deductible), or imposing a 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), or imposing a 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. 

(c) * * *(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 complies for 

one or more plan years with any 

requirement under § 2590.715– 

2713(a)(1)(iv) to provide contraceptive 

coverage if the eligible organization or 

group health plan provides either a copy 

of the self-certification to each issuer 

providing coverage in connection with 

the plan or a notice to the Secretary of 

Health and Human Services that it is an 

eligible organization and of its religious 

objection to coverage for all or a subset 

of contraceptive services. 

(i) When a copy of the selfcertification is provided directly to an 

issuer, the issuer has sole responsibility 

for providing such coverage in 

accordance with § 2590.715–2713. An 

issuer may not require any further 

documentation from the eligible 

organization regarding its status as such. 

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Federal Register / Vol. 79, No. 166 / Wednesday, August 27, 2014 / Rules and Regulations 51101 

(ii) When a notice is provided to the 

Secretary of Health and Human 

Services, the notice must include the 

name of the eligible organization and 

the basis on which it qualifies for an 

accommodation; its objection based on 

its sincerely held religious beliefs to 

coverage of some or all contraceptive 

services, as applicable (including an 

identification of the subset of 

contraceptive services to which 

coverage the eligible organization 

objects, if applicable); the plan name 

and type (i.e., 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 

ERISA section 3(33)); and the name and 

contact information for any of the plan’s 

third party administrators and health 

insurance issuers. If there is a change in 

any of the information required to be 

included in the notice, the organization 

must provide updated information to 

the Secretary of Health and Human 

Services. 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)(1) of this section and 

describing the obligations of the issuer 

under this section. 

(2) * * * (i) A group health insurance 

issuer that receives a copy of the selfcertification or notification described in 

paragraph (c)(1)(ii) of this section with 

respect to a group health plan 

established or maintained by an eligible 

organization in connection with which 

the issuer would otherwise provide 

contraceptive coverage under 

§ 2590.715–2713(a)(1)(iv) must— 

* * * * * 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

For the reasons stated 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 

U.S.C. 300gg through 300gg–63, 300gg–91, 

and 300gg–92), as amended. 

■ 10. Section 147.131 is amended by 

revising paragraphs (c)(1) and (c)(2)(i) 

introductory text to read as follows: 

§ 147.131 Exemption and accommodations 

in connection with coverage of preventive 

health services. 

* * * * * 

(c) * * * (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 complies for 

one or more plan years with any 

requirement under § 147.130(a)(1)(iv) to 

provide contraceptive coverage if the 

eligible organization or group health 

plan provides either a copy of the selfcertification to each issuer providing 

coverage in connection with the plan or 

a notice to the Secretary of Health and 

Human Services that it is an eligible 

organization and of its religious 

objection to coverage for all or a subset 

of contraceptive services. 

(i) When a self-certification is 

provided directly to an issuer, the issuer 

has sole responsibility for providing 

such coverage in accordance with 

§ 147.130. An issuer may not require 

any further documentation from the 

eligible organization regarding its status 

as such. 

(ii) When a notice is provided to the 

Secretary of Health and Human 

Services, the notice must include the 

name of the eligible organization and 

the basis on which it qualifies for an 

accommodation; its objection based on 

its sincerely held religious beliefs to 

coverage of some or all contraceptive 

services, as applicable (including an 

identification of the subset of 

contraceptive services to which 

coverage the eligible organization 

objects, if applicable); the plan name 

and type (i.e., whether it is a student 

health insurance plan within the 

meaning of § 147.145(a) or a church 

plan within the meaning of ERISA 

section 3(33)); and the name and contact 

information for any of the plan’s third 

party administrators and health 

insurance issuers. If there is a change in 

any of the information required to be 

included in the notice, the organization 

must provide updated information to 

the Secretary of Health and Human 

Services. 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)(1) of this section and 

describing the obligations of the issuer 

under this section. 

(2) * * * (i) A group health insurance 

issuer that receives a copy of the selfcertification or notification described in 

paragraph (c)(1)(ii) of this section with 

respect to a group health plan 

established or maintained by an eligible 

organization in connection with which 

the issuer would otherwise provide 

contraceptive coverage under 

§ 147.130(a)(1)(iv) must— 

* * * * * 

[FR Doc. 2014–20252 Filed 8–22–14; 3:30 pm] 

BILLING CODE 4830–01– 4510–29–P; 4120–01–P; 6325– 

64–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Coast Guard 

33 CFR Part 100 

[Docket No. USCG–2014–0686] 

Annual Marine Events in the Eighth 

Coast Guard District, Sabine River; 

Orange, TX 

AGENCY: Coast Guard, DHS. 

ACTION: Notice of enforcement of 

regulation. 

SUMMARY: The Coast Guard will enforce 

Special Local Regulations for the 

Southern Professional Outboard Racing 

Tour (S.P.O.R.T.) boat races to be held 

on the Sabine River in Orange, TX from 

3 p.m. on September 19, 2014, through 

6 p.m. on September 21, 2014. This 

action is necessary to provide for the 

safety of the participants, crew, 

spectators, participating vessels, nonparticipating vessels and other users of 

the waterway. During the enforcement 

period, the Coast Guard Patrol 

Commander will enforce restrictions 

upon, and control the movement of, 

vessels in the zone established by the 

Special Local Regulation. 

DATES: The regulation in 33 CFR 

100.801 will be enforced from 3 p.m. to 

6 p.m. on September 19, 2014; and from 

9 a.m. to 6 p.m. on September 20 and 

21, 2014. 

FOR FURTHER INFORMATION CONTACT: If 

you have questions on this notice of 

enforcement, call or email Mr. Scott 

Whalen, U.S. Coast Guard Marine Safety 

Unit Port Arthur, TX; telephone 409– 

719–5086, email scott.k.whalen@

uscg.mil. 

SUPPLEMENTARY INFORMATION: The Coast 

Guard will enforce Special Local 

Regulation for the annual S.P.O.R.T. 

boat races in 33 CFR 100.801 (Table 3, 

Line 5) on September 19, 2014, from 3 

p.m. to 6 p.m. and on September 20 and 

21, 2014, from 9 a.m. to 6 p.m. 

This Special Local Regulation 

encompasses all waters of the Sabine 

River south of latitude 30°05′33′′ N and 

waters north of latitude 30°05′45′′ N 

North American Datum (NAD 83). 

Under the provisions of 33 CFR 

100.801, a vessel may not enter the 

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