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