In a nod to social and religious conservatives, the rules issued Monday by Sebelius include a provision that would allow religious institutions to opt out of offering birth control coverage.

Health insurance plans must cover birth control as preventive care for women, with no copays, the Obama administration said Monday in a decision with far-reaching implications for health care as well as social mores.

The requirement is part of a broad expansion of coverage for women’s preventive care under President Barack Obama’s health care law. Also to be covered without copays are breast pumps for nursing mothers, an annual “well-woman” physical, screening for the virus that causes cervical cancer and for diabetes during pregnancy, counseling on domestic violence, and other services.

“These historic guidelines are based on science and existing (medical) literature and will help ensure women get the preventive health benefits they need,” said Health and Human Services Secretary Kathleen Sebelius.

The new requirements will take effect Jan. 1, 2013, in most cases. Tens of millions of women are expected to gain coverage initially, and that number is likely to grow with time. At first, some plans may be exempt due to a complex provision of the health care law known as the “grandfather” clause. But those even plans could face pressure from their members to include the new benefit.

Sebelius acted after a near-unanimous recommendation last month from a panel of experts convened by the prestigious Institute of Medicine, which advises the government. Panel chairwoman Linda Rosenstock, dean of public health at the University of California, Los Angeles, said that prevention of unintended pregnancies is essential for the psychological, emotional and physical health of women.

As recently as the 1990s, many health insurance plans didn’t even cover birth control. Protests, court cases, and new state laws led to dramatic changes. Today, almost all plans cover prescription contraceptives — with varying copays. Medicaid, the health care program for low-income people, also covers contraceptives.

Indeed, a government study last summer found that birth control use is virtually universal in the United States, according to a government study issued last summer. More than 90 million prescriptions for contraceptives were dispensed in 2009, according the market analysis firm INS health. Generic versions of the pill are available for as little as $9 a month.

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