45 C.F.R. § 147.133

Moral exemptions in connection with coverage of certain preventive health services

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(a) Objecting entities. (1) Guidelines issued under § 147.130(a)(1)(iv) by the Health Resources and Services Administration must not provide for or support the requirement of coverage or payments for contraceptive services with respect to a group health plan established or maintained by an objecting organization, or health insurance coverage offered or arranged by an objecting organization, to the extent of the objections specified below. Thus the Health Resources and Service Administration will exempt from any guidelines' requirements that relate to the provision of contraceptive services:

(i) A group health plan and health insurance coverage provided in connection with a group health plan to the extent one of the following non-governmental plan sponsors object as specified in paragraph (a)(2) of this section:

(A) A nonprofit organization; or

(B) A for-profit entity that has no publicly traded ownership interests (for this purpose, a publicly traded ownership interest is any class of common equity securities required to be registered under section 12 of the Securities Exchange Act of 1934);

(ii) An institution of higher education as defined in 20 U.S.C. 1002, which is non-governmental, in its arrangement of student health insurance coverage, to the extent that institution objects as specified in paragraph (a)(2) of this section. In the case of student health insurance coverage, this section is applicable in a manner comparable to its applicability to group health insurance coverage provided in connection with a group health plan established or maintained by a plan sponsor that is an employer, and references to “plan participants and beneficiaries” will be interpreted as references to student enrollees and their covered dependents; and

(iii) A health insurance issuer offering group or individual insurance coverage to the extent the issuer objects as specified in paragraph (a)(2) of this section. Where a health insurance issuer providing group health insurance coverage is exempt under paragraph (a)(1)(iii) of this section, the group health plan established or maintained by the plan sponsor with which the health insurance issuer contracts remains subject to any requirement to provide coverage for contraceptive services under Guidelines issued under § 147.130(a)(1)(iv) unless it is also exempt from that requirement.

(2) The exemption of this paragraph (a) will apply to the extent that an entity described in paragraph (a)(1) of this section objects, based on its sincerely held moral convictions, to its establishing, maintaining, providing, offering, or arranging for (as applicable):

(i) Coverage or payments for some or all contraceptive services; or

(ii) A plan, issuer, or third party administrator that provides or arranges such coverage or payments.

(b) Objecting individuals. Guidelines issued under § 147.130(a)(1)(iv) by the Health Resources and Services Administration must not provide for or support the requirement of coverage or payments for contraceptive services with respect to individuals who object as specified in this paragraph (b), and nothing in § 147.130(a)(1)(iv), 26 CFR 54.9815-2713(a)(1)(iv), or 29 CFR 2590.715-2713(a)(1)(iv) may be construed to prevent a willing health insurance issuer offering group or individual health insurance coverage, and as applicable, a willing plan sponsor of a group health plan, from offering a separate policy, certificate or contract of insurance or a separate group health plan or benefit package option, to any group health plan sponsor (with respect to an individual) or individual, as applicable, who objects to coverage or payments for some or all contraceptive services based on sincerely held moral convictions. Under this exemption, if an individual objects to some but not all contraceptive services, but the issuer, and as applicable, plan sponsor, are willing to provide the plan sponsor or individual, as applicable, with a separate policy, certificate or contract of insurance or a separate group health plan or benefit package option that omits all contraceptives, and the individual agrees, then the exemption applies as if the individual objects to all contraceptive services.

(c) Definition. For the purposes of this section, reference to “contraceptive” services, benefits, or coverage includes contraceptive or sterilization items, procedures, or services, or related patient education or counseling, to the extent specified for purposes of § 147.130(a)(1)(iv).

(d) Severability. Any provision of this section held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, shall be construed so as to continue to give maximum effect to the provision permitted by law, unless such holding shall be one of utter invalidity or unenforceability, in which event the provision shall be severable from this section and shall not affect the remainder thereof or the application of the provision to persons not similarly situated or to dissimilar circumstances.

[82 FR 47861, Oct. 13, 2017, as amended at 83 FR 57630, Nov. 15, 2018]

Notes of Decisions

Cited in 7 cases (1 in the last 5 years), 2018–2021 · leading case: Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania

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Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania (2020) scotus “45 C.F.R. § 147.133 (a)(1)(i), (a)(2). Unless otherwise noted, this opinion refers to the religious and moral exemptions together as "the exemption" or "the blanket exemption.”

Commonwealth of Pennsylvania v. President United States (2019) ca3 “Like the Religious IFR, the Final Rule creating the Religious Exemption expanded the categories of employers who are permitted to invoke the exemption from the Contraceptive Mandate to include all nonprofit, for-profit, and publicly-held companies.”

Commonwealth v. U.S. Dep't of Health & Human Servs. (2018) dcd “45 C.F.R. § 147.133 (a)(2). E. Previous litigation by Dordt College and March for Life In October, 2013, Dordt College brought a civil action against the federal government, alleging that the contraceptive mandate violated the Religious Freedom Restoration Act (RFRA), the APA…”

Com. of Mass. v. U.S. Dep't of Health & Human Servs. (2018) dcd “45 C.F.R. § 147.133 (a)(2). D. Estimated Impact of the IFRs The Departments provided two estimates for the number of women who will *253 likely be affected by the IFRs nationwide.”

COMMONWEALTH OF MASSACHUSETTS v. U.S. Dept. of Health & Human Services (2018) mad “45 C.F.R. § 147.133 (a)(2). E. Previous litigation by Dordt College and March for Life In October, 2013, Dordt College brought a civil action against the federal government, alleging that the contraceptive mandate violated the Religious Freedom Restoration Act (RFRA), the APA…”

COMMONWEALTH OF MASSACHUSETTS v. U.S. Dept. of Health & Human Services (2018) mad “45 C.F.R. § 147.133 (a)(2). D. Estimated Impact of the IFRs The Departments provided two estimates for the number of women who will likely be affected by the IFRs nationwide.”

COMMONWEALTH OF MASSACHUSETTS v. U.S. Dept. of Health & Human Services (2021) mad “45 C.F.R. § 147.133 (a)(2). The IFRs were superseded by the Final Rules issued in November, 2018, which became effective in January, 2019.”

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