Contraceptive Accommodation Choice Enrollment Form

What is contraceptive accommodation?

Some employers can object to contraceptive coverage, but the Affordable Care Act says you can ask us to make an exception for you. This is known as a "contraceptive accommodation." That means contraceptives can still be covered by your Blue Cross or BCN plan, at no cost to you.

If you have already filled out this form and are currently enrolled in our contraceptive accommodation program, formerly known as "religious accommodation," you don’t need to enroll again.

Depending on your plan, this coverage may include medical services, such as voluntary sterilization, contraceptive counseling and intrauterine devices, as well as generic, select brand-name and specific over-the-counter prescription contraceptive drugs.

We'll send you a letter with more information about the coverage.

To get started, fill out the Contraceptive Accommodation Choice Enrollment form (PDF). You may have received this in the mail as the CA Choice Enrollment form.

When filling out the form, you'll need to know your:

  • Social Security number
  • Group number or Group ID number (found on your Blue Cross or BCN member ID card)
  • Subgroup (also on your ID card)
  • Class ID (also on your ID card)

After you complete the form, mail or fax it to the address or number listed on the form so we can get you enrolled.

Contraceptive Accommodation Limited Choice ID card

After you're enrolled, we'll send you the CA Choice Limited ID card. Present the card when you get covered contraceptive services or prescription drugs from a participating Blue Cross or BCN provider. When you present your CA Limited Choice ID card, you don’t have to pay for anything. The provider will send us the bill.

But if you don’t show your CA Limited Choice ID card, we can't pay for your contraceptive services or prescriptions. If that happens, you'll need to contact your doctor or pharmacist to adjust your bill with the information from this card.

If you paid for a contraceptive service or prescription before you got your card, you'll need to go through the appeals process for reimbursement.

Note: Members who are already enrolled may continue to use their RA Limited Choice ID cards. 

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