Earlier this month, the 10th US Circuit Court of Appeals ruled against the Little Sisters and other religious entities seeking relief from having to facilitate contraceptive coverage in employee health insurance.

Churches and other institutions that primarily employ and serve members of the churches are exempt, but the Little Sisters didn't fall within this category, the court ruled.

The Little Sisters objected to having to file a form with federal authorities, under an "accommodation", that triggered a requirement for insurance companies to pay for the contraceptive coverage.

Sister Loraine Marie Maguire, mother provincial of the order, said the Little Sisters were being asked to choose between adhering to their Catholic faith and continuing to pursue their religious mission of serving the elderly poor.

The order faces heavy fines if it doesn't comply with the mandate.

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The Tenth Circuit Court ruled that the Little Sisters are not an exempt religious institution because they are not directly affiliated with any particular house of worship.

The court said that the Obama administration has provided sufficient accommodation for non-profit organisations—such as the Little Sisters—that have moral objections to providing contraceptive coverage in employee health insurance plans.

Under the latest plan, the Little Sisters would be required to provide the federal government with a formal declaration that they object to the contraceptive mandate.

By filing that form, they would trigger government action requiring their insurer to pay for contraceptive coverage.

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