In a year already marked by overwhelming legislative and regulatory change, group health plans now must address yet another issue—abortion coverage in the wake of the U.S. Supreme Court's recent decision in Dobbs v. Jackson Women's Health Org. The court overruled Roe v. Wade, eliminating the constitutional right to abortion and leaving states free to regulate the procedure—and health plan sponsors wondering what to do next.

The Dobbs decision, and the actions of state legislatures in reaction to it, will have significant repercussions for benefit plan sponsors. The issues range from the more obvious, such as how group health plans may provide coverage for abortion services, to the more opaque, such as whether employers may provide excludable reimbursements for abortion-related travel expenses and whether participants may be reimbursed for such expenses through health reimbursement arrangements (HRAs). There are more questions at this point than answers.

Two factors that will significantly affect a plan sponsor's options are whether the plan is subject to ERISA and whether it is self-funded or fully insured.