The NALC Health Benefit Plan covers Contraceptives at no cost to you when you use an in-network provider or pharmacy!
Under the Affordable Care Act, your plan covers contraceptive medications and medical devices approved by the U.S. Food and Drug Administration. The NALC Health Benefit Plan covers a full range of contraceptive medications at a zero dollar member cost share, such as:
- Oral contraceptives
- Barrier Methods – Cervical Caps and Diaphragms
- Intrauterine Devices
- Subdermal Rods and Vaginal Rings
- Transdermal Patches
- Female Condoms
- Injectable Contraceptives
- Vaginal Sponges
- Spermicides
- Vaginal pH Modulators
- Male Condoms
For detailed coverage on contraceptive counseling, office visits, over-the-counter medications or related services, see the Family Planning or Preventive care medications sections of the Plan’s brochure.
To learn about your reproductive right and reproductive health, visit U.S. Department of Health and Human Services at https://www.justice.gov/archives/reproductive-rights/patients-and-providers.
Reimbursement for Over-the-Counter Contraceptives
To receive reimbursement for over-the-counter contraceptives, you must submit a short-term prescription form to the NALC Prescription Drug Program. Complete the short-term prescription claim form, attach the drug receipts and mail to the NALC Prescription Drug Program. NALC Prescription Drug Program P.O. Box 52192 Phoenix, AZ 85072-2192.
Exceptions Process for Contraceptives
Any contraceptive that is not already available without cost sharing on the formulary can be accessed through the contraceptive exceptions process. Your healthcare provider can seek a contraceptive exception by calling CVS Caremark® Prior Authorization at 800-294-5979 or complete the Preventive Services Contraception Zero Copay Exception Form. If approved, the requested service or product will be covered at no cost share to you.
Contact OPM
If individuals have concerns about the plan’s compliance, the requirements mentioned or other OPM guidance, you can contact OPM directly at contraception@opm.gov. You can find more information concerning Contraceptive coverage on the OPM website.
How to locate at in-network provider:
- Cigna PPO provider call 877-220-NALC (6252) or search the online directory
- NALC CareSelect Network pharmacy near you, visit the CVS Caremark® website
