Contraceptive Equity Act
Summary: The Equity in Prescription Insurance and Contraceptive Coverage Act prohibits health insurance plans that cover prescription drugs and devices from refusing coverage for contraceptives.
Section 1. Short Title
This Act may be cited as the “Equity in Prescription Insurance and Contraceptive Coverage Act.”
Section 2. Findings and Purpose
(A) FINDINGs—The legislature finds that:
1. Insurance coverage of contraceptives is insufficient. Three-quarters of women of childbearing age rely on some form of private employment-related insurance to defray their medical expenses, yet nearly half of all typical large group insurance plans do not routinely cover any contraceptive method.
2. Nationally, 97 percent of large group insurance plans routinely cover prescription drugs, but only 15 percent routinely cover all five primary reversible contraceptive methods: oral contraception, IUD insertion, diaphragm, Norplant insertion, and Depo-Provera injection.
3. In [State], [number or percentage] of insurance plans do not provide coverage for [the full range of/any] contraceptives.
(B) PURPOSE—This law is enacted to protect the health and safety of women of childbearing age and to remedy inequity in health insurance coverage.
SECTION 3. CONTRACEPTIVE EQUITY
(A) Definitions—In this section:
1. “Covered person” means a policy holder, subscriber, certificate holder, enrollee, or other individual who participates in or receives coverage under a health insurance plan.
2. “Health insurance plan” means any individual or group plan, policy, certificate, subscriber contract, or contract of insurance that is delivered, issued, renewed, modified, amended or extended by a health insurer.
3. “Health insurer” means a disability insurer, health care insurer, health maintenance organization, accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, health service corporation, health care service plan, preferred provider organization or arrangement, self-insured employer, or multiple employer welfare arrangement.
4. “Outpatient contraceptive services” means consultations, examinations, procedures and medical services provided on an outpatient basis and related to the use of contraceptive drugs and devices to prevent pregnancy.
(B) Parity For Contraceptives
1. Health insurance plans that provide benefits for prescription drugs or devices shall not exclude or restrict benefits for any prescription contraceptive drug or device approved by the Food and Drug Administration. [Optional: Health care plans must allow enrollees to obtain at least a 90-day supply of oral contraceptives per refill.]
2. Health insurance plans that provide benefits for outpatient services provided by a health care professional shall not exclude or restrict outpatient contraceptive services for covered persons.
(C) Extraordinary Surcharges Prohibited
A health insurance plan is prohibited from:
1. Imposing deductibles, copayments, other cost-sharing mechanisms, or waiting periods for prescription contraceptive drugs or devices that are greater than deductibles, copayments, other cost-sharing mechanisms, or waiting periods for other covered prescription drugs or devices.
2. Imposing deductibles, copayments, other cost-sharing mechanisms, or waiting periods for outpatient contraceptive services that are greater than deductibles, copayments, other cost-sharing mechanisms, or waiting periods for other covered outpatient services.
(D) Other Prohibitions
A health insurance plan is prohibited from:
1. Denying eligibility, continued eligibility, enrollment, or renewal of coverage to any individual because of their use or potential use of contraceptives.
2. Providing monetary payments or rebates to covered persons to encourage them to accept less than the minimum protections available under this section.
3. Penalizing, or otherwise reducing or limiting the reimbursement of a health care professional because such professional prescribed contraceptive drugs or devices, or provided contraceptive services.
4. Providing incentives, monetary or otherwise, to a health care professional to induce such professional to withhold contraceptive drugs, devices or services from covered persons.
(E) Enforcement
In addition to any remedies at common law, the [insurance commissioner] shall receive and review written complaints regarding compliance with this section. The [insurance commissioner] may use all investigatory tools available to verify compliance with this section. If the [insurance commissioner] determines that a health insurance plan is not in compliance with any section in this section, the [commissioner] shall:
1. Impose a fine of up to $10,000 per violation of this section. An additional $10,000 may be imposed for every 30 days that a health insurance plan is not in compliance; and
2. Suspend or revoke the certificate of authority or deny the health insurer’s application for a certificate of authority.
Section 4. Severability
The provisions of this Act shall be severable, and if any phrase, clause, sentence, or provision is declared to be invalid or is preempted by federal law or regulation, the validity of the remainder of this Act shall not be affected.
SECTION 5. EFFECTIVE DATE
This Act shall take effect on July 1, 2006. This Act shall apply to any health insurance plan delivered, issued, renewed, modified, amended or extended on or after the effective date.