"Issuers are prohibited from charging any premium, fee, or other charge to eligible organizations or their plans, or to plan participants or beneficiaries, for making payments for contraceptive services, and must segregate the premium revenue collected from eligible organizations from the monies they use to make such payments," the rule said.
"In making such payments, the issuer must ensure that it does not use any premiums collected from eligible organizations."
This places the burden of payment for the objectionable products on the insurance issuers themselves.
Asked during a press call how the insurance issuers would be reimbursed for these payments, an HHS official responded that they would not need to do so because paying for birth control is "cost-neutral" for them, due to the resulting decline in childbirth costs and the other "health benefits" afforded by contraception.
However, the idea that contraceptives can be offered free of cost was rejected by pharmacy directors in a national survey shortly after the accommodation was initially announced last year.
Religious freedom advocates initially responded to the announcement of the final rule – which was more than 100 pages in length – by indicating a desire to examine it more closely in order to see whether it adequately addresses the religious freedom concerns that had been raised.
Among these concerns was the complaint that religious employers under the "accommodation" would still be facilitating the objectionable coverage because the plans that they offer are necessary to "trigger" the contraception coverage or funding.
Some critics of the mandate also warned that insurance companies would find that contraception was not actually "cost-neutral" any may ultimately end up funding it by raising the cost of the objecting employers' premiums.
The question of religious individuals running for-profit businesses had also been discussed. More than a dozen for-profit companies have filed lawsuits over the mandate, including arts and crafts giant Hobby Lobby and several other manufacturers, publishers, medical groups and other employers. However, the final rule does not allow any accommodation for these employers.