Last year's contraceptive compromise completed: Federal government will pick up tab for contraceptive coverage at religious nonprofits with self-funded insurance plans

Today, HHS answers a question that arose last February when the administration announced its compromise regarding insurance coverage for contraception at faith-based nonprofits that objected to the coverage on moral grounds (places of worship do not have to provide contraceptive coverage at all). Here is the question as I framed it last February: 

Under the  compromise,

• Religious organizations will not be required to subsidize the cost of contraception.

• Contraception coverage will be offered to women by their employers’ insurance companies directly [and free of charge], with no role for religious employers who oppose contraception.

Question: more than half of Americans who get their health coverage from their employers are in self-funded plans -- that is, plans in which the employer sets aside funds to cover the cost of health care, usually hiring a third party administrator (TPA) to handle the claims process, as well as a stop-loss insurer to cover costs above a certain level.  So: who will "provide contraception coverage" in self-funded plans?   If it's the self-funded entity, then the employer is paying for it. Would the TPA somehow absorb the cost -- or a stop-loss insurer under some special rider? If so, surely either would find a way to pass the cost back? 

And lo, here is the answer, published today by HHS:

Religious exemption for contraceptive coverage: who pays when the employer is self-insured? (cont.)

When the administration announced its compromise regarding the requirement that all health plans offer free contraception -- i.e., that if an employer objected on grounds of conscience, the insurer, not the employer, would pay -- I wondered immediately how that would work in the case of the large number of employers whose health plans are self-insured. Who would pay in cases where the employer is the insurer?

My guesses included the third party administrator (TPA) usually hired to run such plans. But that did not seem entirely to make sense, because a) not all self-funded plans use TPAs, and b) the TPA, by definition, does not fund the services provided.  Requiring them to pay for contraception would be a little like requiring outsourced payroll-handling services to pay for, say, ergonomic chairs.

Yesterday, HHS Secretary Kathleen Sebelius rendered an answer of sorts. The Times' Robert Pear reports: