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Pill bills: States that mandate contraceptive equality

Expanding insurance coverage of contraceptives is not only law in certain states, but it's also a national public policy goal. "Healthy People 2010," written by the Department of Health and Human Services (HHS), provides a set of national health objectives that will reduce preventable threats to health.

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According to HHS, "Reducing unintended pregnancies is possible and necessary. Unintended pregnancy in the United States is serious and costly and occurs frequently. Socially, the costs can be measured in unintended births, reduced educational attainment and employment opportunity, greater welfare dependency, and increased potential for child abuse and neglect. Economically, health care costs are increased."

Studies show that it is far less expensive for health insurers to cover contraceptives than the alternative: To pay for pregnancy-related care. HHS says, "Unintended pregnancy is expensive, and contraceptives save health care resources by preventing unintended pregnancy. The pregnancy care cost for one woman who does not intend to be pregnant . . . is estimated at about $3,200 annually in a managed care setting" (such as an HMO plan).

Twenty-four states require that health insurers cover contraceptives, up from 20 in 2004, according to the National Women's Law Center (NWLC). Generally, these state laws say that if a health insurance policy includes coverage for prescription drugs, it must also cover prescription contraceptives, according to NWLC. However, these mandates to not apply to self-insured plans and most states allow religious employers such as churches to refuse to carry contraceptive coverage.

In addition, three states (Michigan, Montana and Wisconsin) have state anti-discrimination laws (but not specifically contraceptive equality laws) that have been interpreted to require contraceptive equity, according to NWLC.

States without these "pill bills" continue to introduce them, and contraceptive-equality laws in California and New York have been challenged and upheld, according to NWLC, giving future efforts a boost.

According to the Council for Affordable Health Insurance, adding contraceptive coverage to a policy costs an additional 1 to 3 percent.

If your state has a contraceptive-equality law, here's what it says.

Arizona

Group health insurance policies that provide coverage for prescription drugs must cover prescription drugs and devices approved by the FDA for use as contraceptives. The insurer may not impose deductibles, coinsurance, copayments, or other cost containment measures for contraceptive drugs that are greater than the deductibles, coinsurance, copayments, or other cost containment measures for other drugs. If the insurer provides coverage for outpatient health care services, it must provide coverage for outpatient contraceptive services, including consultations, examinations, procedures, and medical services.

Does not apply to health plans issued to a small business of 2 to 25 employees.

Religious employers may refuse to provide coverage. The religious exception does not permit the exclusion of coverage for prescription contraceptive methods ordered for medical indications other than to prevent an unintended pregnancy.

Arkansas

Every individual or group plan, policy, or contract for health care services that provides coverage for prescription drugs on an outpatient basis must provide coverage for prescribed drugs or devices approved by the FDA for use as a contraceptive. No insurer may impose upon any person receiving prescription contraceptives any copayment, coinsurance payment, or fee that is not equally imposed upon all individuals receiving benefits for prescription drugs in the same benefit category. There may be no reduction in allowable reimbursement for prescription drug benefits imposed upon the enrollee receiving prescription contraceptives.

Religious employers may refuse to provide coverage.

California

Every individual or group health insurance policy that provides coverage for outpatient prescription drug benefits must include coverage for a variety of FDA-approved prescription contraceptive methods, as designated by the insurer, under the same terms and conditions as are applicable to all other benefits. If an insured’s health care provider determines that none of the methods designated by the insurer is medically appropriate for the insured’s medical or personal history, the insurer must provide coverage for some other FDA-approved prescription contraceptive method prescribed by the patient’s health care provider.

Outpatient prescription coverage must be identical for an insured’s covered spouse and covered nonspouse dependents.

Religious employers may refuse to provide coverage. The religious exception does not exclude coverage for prescription contraceptive supplies ordered for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for prescription contraception that is necessary to preserve the life or health of an insured.

Connecticut

Each individual and group health insurance policy that provides coverage for outpatient prescription drugs approved by the FDA must include coverage for prescription contraceptive methods approved by the FDA.

Religious employers may refuse to provide coverage. Also, an individual may request that an insurer issue to the individual a health insurance policy that excludes coverage for prescription contraceptive methods if he or she states in writing that prescription contraceptive methods are contrary to his or her religious or moral beliefs. The religious exception does not permit the exclusion of coverage for prescription drugs ordered for reasons other than contraceptive purposes.

Delaware

All group and blanket health issuance policies that provide coverage for outpatient prescription drugs must provide coverage, under terms and conditions applicable to other benefits, for prescription contraceptive drugs and devices approved by the FDA and for outpatient contraceptive services.

An insurer may not impose a copayment, coinsurance requirement, or deductible for directly accessed gynecological services related to prescription contraceptives, unless such additional cost-sharing is imposed for access to health care practitioners for other types of health care.

The contraceptive coverage requirement applies to the enrollee and all insured parties covered by the health policy.

Religious employers may refuse to provide coverage.

Georgia

Every individual or group health plan, policy or contract that provides coverage for prescription drugs on an outpatient basis must provide coverage for any prescription drug or device approved by the FDA for use as a contraceptive.

No insurer may impose upon any person receiving prescription contraceptive benefits any copayment, coinsurance payment, or fee that is not equally imposed upon all individuals in the same benefit category, class, coinsurance level, or copayment level receiving benefits for prescription drugs, and no insurer may reduce the allowable reimbursement for prescription drug benefits for any person receiving prescription contraceptive benefits.

Hawaii

Each employer group health policy, contract, plan, or agreement must include coverage for prescription contraceptive drugs and devices approved by the FDA and for outpatient contraceptive services for the subscriber or any dependent of the subscriber who is covered by the policy.

All policies that provide prescription contraceptive drugs and devices and outpatient contraceptive services cannot exclude any prescription contraceptive drugs or devices or impose any unusual copayment, charge, or waiting requirement for a contraceptive drug or device.

Insurers must provide coverage for at least one brand of monophasic, multiphasic and progestin-only contraceptives, and an insured person may receive coverage for a different brand of oral contraceptives only if the covered brands have resulted in an adverse drug reaction or if the insured person has not used the covered brands and the prescribing physician believes that, based on the insured person’s past medical history, the covered brands would cause an adverse drug reaction.

Religious employers may refuse to provide coverage. The religious exception does not permit the exclusion of coverage for prescription contraceptive supplies ordered for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for prescription contraception that is necessary to preserve the life or health of an enrollee.

Health insurers must allow enrollees in a health plan exempted for religious reasons to directly purchase coverage of contraceptive supplies and outpatient contraceptive services.

Illinois

An individual or group health insurance policy that provides coverage for outpatient services and outpatient prescription drugs or devices must provide coverage for all outpatient contraceptive services and all outpatient contraceptive drugs and devices approved by the FDA.

An insurer may not impose any deductible, coinsurance, waiting period, or other cost-sharing or limitation that is greater than that required for any outpatient service or outpatient prescription drug or device otherwise covered by the policy.

An insurance company is not required to cover services related to abortion or permanent sterilization that requires a surgical procedure.

Iowa

An individual or group health insurance policy or contract may not exclude or restrict benefits for FDA-approved prescription contraceptive drugs or devices, or their generic equivalents, if such policy or contract provides benefits for other outpatient prescription drugs or devices, nor may an individual or group health insurance policy or contract exclude or restrict outpatient contraceptive services to prevent conception if such policy or contract provides benefits for other outpatient services provided by a health care professional. In the case of an individual policy or contract, the individual policyholder may reject the contraceptive coverage provision at his or her option.

A deductible, coinsurance or copayment for benefits for prescription contraceptive drugs, devices, or outpatient services may not be greater than any deductible, coinsurance or copayment for any other outpatient prescription drug, device, or outpatient health care service that is covered under the policy.

Coverage of benefits for experimental or investigational contraceptive drugs and devices or services is required only to the extent that the policy or contract provides coverage for other experimental or investigational outpatient prescription drugs, devices, or outpatient health care services.

Iowa law prohibits insurers from excluding contraceptive users from coverage, penalizing health care providers for providing contraceptives, or offering incentives not to accept or provide contraceptive coverage to individuals or health care providers.

Maine

All individual or group health insurance plans that provide coverage for prescription drugs must provide coverage for all prescription contraceptives approved by the FDA. Plans that cover outpatient medical services must cover outpatient contraceptive services to the same extent that coverage is provided for other prescription drugs or outpatient medical services. This requirement does not apply to prescription drugs or devices that are designed to terminate a pregnancy.

Religious employers may refuse to provide coverage. The religious exclusion does not permit the exclusion of coverage for contraceptive drugs prescribed for reasons other than contraceptive purposes or for prescription contraception that is necessary to preserve the life or health of a covered person.

Maryland

Insurers, nonprofit health service plans, and health maintenance organizations that provide coverage for prescription drugs under individual or group health insurance policies or contracts must provide coverage for any contraceptive drug or device that is approved by the FDA for use as a prescription contraceptive. Insurers must also provide coverage for any medically necessary examination associated with the use of a contraceptive drug or device.

An insurer may not impose a different copayment or coinsurance for a contraceptive drug or device than is imposed for any other prescription.

Religious employers may refuse to provide coverage.

Massachusetts

An individual or group plan that provides benefits for prescription drugs, devices, and outpatient services must provide to residents of Massachusetts, and to persons having a principal place of employment within Massachusetts, benefits for prescription contraceptive drugs, devices and outpatient services.

Insurers must provide prescription contraceptive drugs, devices and outpatient services under the same terms and conditions as for other prescription drugs, devices and outpatient services.

Churches may refuse to provide coverage.

Missouri

Each health carrier or health benefit plan that provides coverage for pharmaceutical benefits must provide coverage for FDA-approved contraceptives either at no charge or at the same level of deductible, coinsurance or copayment as any other covered drug. “Contraceptives” is defined to exclude all drugs and devices intended to induce an abortion, but there is no exclusion for any drugs or devices prescribed for reasons other than contraceptive or abortion purposes.

Religious employers may refuse to provide coverage. Also, an individual enrollee who is a member of a group health benefit plan, and who states that the use or provision of contraceptives is contrary to his or her moral, ethical or religious beliefs, may be issued a policy that excludes coverage for contraceptives.

Nevada

An individual or group health insurer that provides coverage for prescription drugs or devices must cover FDA-approved prescription contraceptive drugs and devices.

Insurers are prohibited from requiring a higher deductible, copayment or coinsurance, or requiring longer waiting periods, for contraceptive drugs than for other prescription drugs. Nevada prohibits insurers from excluding contraceptive users from coverage, penalizing health care providers for providing contraceptive coverage, or offering incentives not to accept or provide contraceptive coverage to individuals or health care providers.

Religious employers may refuse to provide coverage.

New Hampshire

Each insurer that covers prescription drugs must cover all FDA-approved prescription contraceptive drugs and devices under the same terms and conditions as it covers other prescription drugs.

Each insurer that issues or renews a health group insurance policy covering outpatient services also must cover outpatient contraceptive services under the same terms and conditions as it covers other outpatient services. Outpatient contraceptive services are defined to mean outpatient consultations, examinations and medical services related to the use of FDA-approved contraceptive methods to prevent pregnancy.

New Jersey

Each hospital service corporation, medical service corporation, health service corporation, group health insurer, individual insurer, health maintenance organization, individual health benefits plan, small employer health benefits plan, or prepaid prescription service organization that provides hospital or medical expense benefits for expenses incurred in the purchase of outpatient prescription drugs is required to provide coverage for expenses incurred in the purchase of any prescription contraceptive drug or device approved by the FDA.

Religious employers may refuse to provide coverage.

New Mexico

Each individual and group health insurance policy, health care plan, certificate of health insurance, and health maintenance contract that offers a prescription drug benefit must offer coverage for FDA-approved prescription contraceptive drugs or devices.

Insurers must provide prescription contraceptive drugs and devices at the same level of deductible or coinsurance as any other covered benefit.

Religious employers may refuse to provide coverage.

New York

Every group or blanket policy that provides coverage for prescription drugs must include coverage for the cost of FDA-approved prescription contraceptive drugs or devices or their generic equivalents.

Religious employers may refuse to provide coverage. An individual has the right to directly purchase a contraceptive coverage rider from the insurer, at the prevailing small group community rate, if his or her employer claims the religious exemption. The religious exception does not permit the exclusion of coverage for contraceptive drugs prescribed for reasons other than contraceptive purposes.

North Carolina

Every insurer providing an individual or group health benefit plan that provides coverage for prescription drugs and devices must provide coverage for FDA-approved prescription contraceptive drugs or devices. Coverage must include coverage for the insertion and removal of, and any medically necessary examination associated with, the use of the prescribed contraceptive drug or device.

Every insurer providing a health benefit plan that provides coverage for outpatient services provided by a health care professional must provide coverage for outpatient contraceptive services.

Contraceptives and contraceptive outpatient services may be provided subject to the same deductibles, coinsurance or other limitations as those that apply to other prescription drugs or outpatient services. A health benefit plan may require that the total coinsurance, based on the useful life of the drug or device, be paid in advance for those drugs or devices that are inserted or prescribed and do not have to be refilled on a periodic basis.

Religious employers may refuse to provide coverage. The religious exception does not permit the exclusion of coverage for contraceptive drugs prescribed for reasons other than contraceptive purposes, or for prescription contraception that is necessary to preserve the life or health of a person covered under the plan.

Oregon

Each prescription drug benefit program or prescription drug benefit offered under a health benefit plan or under a student health insurance policy must provide payment, coverage or reimbursement for FDA-approved prescription contraceptives and, if covered for other drug benefits under the program, plan or policy must provide outpatient consultations, examinations, procedures and medical services necessary to prescribe, dispense, deliver, distribute, administer or remove a prescription contraceptive.

Religious employers may refuse to provide coverage.

Rhode Island

Every individual or group health insurance contract, plan or policy that provides prescription coverage must provide coverage for FDA-approved prescription contraceptive drugs and devices. Coverage for the prescription drug RU 486 is not required.

Religious employers may refuse to provide coverage.

Vermont

Any individual or group health insurance plan must provide coverage for outpatient contraceptive services, including sterilizations, and must provide coverage for all FDA-approved prescription contraceptive drugs and devices if the plan provides coverage for other prescription drugs.

An insurer may not establish any rate, term or condition that places a greater financial burden on an insured or beneficiary for access to contraceptive services or prescription contraceptive drugs and devices than for access to treatment, prescriptions or devices for any other health condition.

Washington

It is unlawful under state law for any health carrier doing business in the state to restrict, exclude or reduce coverage or benefits under any individual or group health plan on the basis of sex. A health plan providing generally comprehensive coverage of prescription drugs and devices is committing sex discrimination in violation of this provision if it fails to cover prescription contraceptives.

A plan that provides generally comprehensive coverage of prescription drugs or devices may not exclude prescription contraceptives or cover prescription contraceptives on a less favorable basis than other covered prescription drugs and devices. Prescription contraceptives include all FDA-approved contraceptive drugs and devices.

Health plans may not impose benefit waiting periods, limitations or restrictions on prescription contraceptives that are not required or imposed on other covered prescription drugs or devices. A plan may require cost sharing, such as copayments or deductibles, for prescription contraceptives or associated services, only to the same extent that such cost sharing is required for other covered prescription drugs, devices or services.

Washington law does not contain any religious refusal clause. Washington state law permits an employer with a religious or moral tenet opposed to a specific health care service to choose not to purchase insurance coverage for that service if it objects to doing so for reason of conscience or religion, so long as an enrollee is not denied coverage of such service. However, the state Attorney General has determined that this provision does not permit an employer to decline contraceptive coverage for reasons of conscience or religion, noting that while an employer may not be compelled to purchase for its employees coverage to which it has a conscientious objection, it must find a way to cover the costs of contraceptive coverage for its employees.

West Virginia

Individual or group health insurance plans that provide benefits for prescription drugs or devices in prescriptive drug plans may not exclude or restrict benefits to covered persons, not including dependent children, for any prescription contraceptive drug or device approved by the FDA. Also, any health insurance plan that provides benefits for prescription drugs or devices in a prescription drug plan and that provides benefits for outpatient services provided by a health care professional may not exclude or restrict outpatient contraceptive services for covered persons for prescription contraceptives or devices.

A health insurance plan may not impose deductibles, copayments, other cost-sharing mechanisms, or waiting periods for prescription contraceptive drugs or devices greater than those for other covered prescription drugs or devices or other covered outpatient services. Also, a health insurance plan may not deny eligibility, enrollment or renewal to any individual because of her use or potential use of contraceptives or provide monetary payments or rebates to covered persons to encourage them to accept less than minimum protections available.

Religious employers may refuse to provide coverage.

Source: National Women's Law Center. Used with permission.

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