2023 -- S 0562
========
LC001964
========
S TATE OF RHODE IS LAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Senators Euer, DiMario, Miller, Cano, Sosnowski, Mack, Zurier,
LaMountain, Gu, and Lawson
Date Introduced: March 07, 2023
Referred To: Senate Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Section 27-18-57 of the General Laws in Chapter 27-18 entitled "Accident 1
and Sickness Insurance Policies" is hereby amended to read as follows: 2
27-18-57. F.D.A. approved prescription contraceptive drugs and devices. 3
(a) Every individual or group health insurance contract, plan, or policy issued pursuant to 4
this title that provides prescription coverage and is delivered, issued for delivery, or renewed, 5
amended or effective in this state on or after January 1, 2024 shall provide coverage for F.D.A. 6
approved contraceptive drugs and devices requiring a prescription all of the following services and 7
contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or 8
require coverage for the prescription drug RU 486. 9
(1) All FDA-approved contraceptive drugs, devices, and other products. The following 10
applies to this coverage: 11
(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 12
product, the contract shall include either the original FDA-approved contraceptive drug device, or 13
product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same 14
definition as that set forth by the FDA; 15
(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 16
available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 17
blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 18
contraceptive drug, device, or product, based on the determination of the health care provider, 19
LC001964 - Page 2 of 15
without cost-sharing; 1
(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-2
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 3
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 4
management restrictions. 5
(2) Voluntary sterilization procedures; 6
(3) Clinical services related to the provision or use of contraception, including 7
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 8
education, referrals, and counseling; and 9
(4) Follow-up services related to the drugs, devices, products, and procedures covered 10
under this section, including, but not limited to, management of side effects, counseling for 11
continued adherence, and device insertion and removal. 12
(b) A group or blanket policy subject to this section shall not impose a deductible, 13
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 14
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 15
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 16
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 17
withdrawals from his or her health savings account under 26 U.S.C. § 223. A health plan shall not 18
impose utilization control or other forms of medical management limiting the supply of FDA-19
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 20
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 21
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 22
such coverage other than a pharmacy claim. 23
(c) Except as otherwise authorized under this section, a group or blanket policy shall not 24
impose any restrictions or delays on the coverage required under this section. 25
(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 26
spouse or domestic partner and covered non-spouse dependents. 27
(b)(e) Notwithstanding any other provision of this section, any insurance company may 28
issue to a religious employer an individual or group health insurance contract, plan, or policy that 29
excludes coverage for prescription contraceptive methods that are contrary to the religious 30
employer’s bona fide religious tenets. The exclusion from coverage under this provision shall not 31
apply to contraceptive services or procedures provided for purposes other than contraception, such 32
as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. 33
(c)(f) As used in this section, “religious employer” means an employer that is a “church or 34
LC001964 - Page 3 of 15
a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 1
(d)(g) This section does not apply to insurance coverage providing benefits for: (1) Hospital 2
confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare 3
supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily 4
injury or death by accident or both; and (9) Other limited-benefit policies. 5
(e)(h) Every religious employer that invokes the exemption provided under this section 6
shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 7
contraceptive healthcare services the employer refuses to cover for religious reasons. 8
(f)(i) Beginning on the first day of each plan year after April 1, 2019, every health insurance 9
issuer offering group or individual health insurance coverage that covers prescription contraception 10
shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three 11
hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the 12
course of the twelve (12) month period at the discretion of the prescriber. 13
(j) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 14
devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 15
ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 16
preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 17
accordance with § 27-18-20. The department may base its determinations on findings from onsite 18
surveys, enrollee or other complaints, financial status, or any other source. 19
(k) The department shall monitor plan compliance in accordance with this section and shall 20
adopt rules for the implementation of this section, including the following: 21
(1) In addition to any requirements under state administrative procedures, the department 22
shall engage in a stakeholder process prior to the adoption of rules that include health care service 23
plans, pharmacy benefit plans, consumer representatives, including those representing youth, low-24
income people, and communities of color, and other interested parties. The department shall hold 25
stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider 26
factors and processes relevant to contraceptive coverage. The department shall provide notice of 27
stakeholder meetings on the department's website, and stakeholder meetings shall be open to the 28
public. 29
(2) The department shall conduct random reviews of each plan and its subcontractors to 30
ensure compliance with this section. 31
(3) The department shall submit an annual report to the general assembly and any other 32
appropriate entity with its findings from the random compliance reviews detailed in this section 33
and any other compliance or implementation efforts. This report shall be made available to the 34
LC001964 - Page 4 of 15
public on the department’s website. 1
SECTION 2. Section 27-19-48 of the General Laws in Chapter 27-19 entitled "Nonprofit 2
Hospital Service Corporations" is hereby amended to read as follows: 3
27-19-48. F.D.A. approved prescription contraceptive drugs and devices. 4
(a) Every individual or group health insurance contract, plan, or policy issued pursuant to 5
this title that provides prescription coverage and is delivered, issued for delivery, or renewed, 6
amended or effective in this state on or after January 1, 2024 shall provide coverage for F.D.A. 7
approved contraceptive drugs and devices requiring a prescription all of the following services and 8
contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or 9
require coverage for the prescription drug RU 486. 10
(1) All FDA-approved contraceptive drugs, devices, and other products. The following 11
applies to this coverage: 12
(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 13
product, the contract shall include either the original FDA-approved contraceptive drug device, or 14
product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same 15
definition as that set forth by the FDA; 16
(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 17
available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 18
blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 19
contraceptive drug, device, or product, based on the determination of the health care provider, 20
without cost-sharing; 21
(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-22
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 23
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 24
management restrictions. 25
(2) Voluntary sterilization procedures; 26
(3) Clinical services related to the provision or use of contraception, including 27
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 28
education, referrals, and counseling; and 29
(4) Follow-up services related to the drugs, devices, products, and procedures covered 30
under this section, including, but not limited to, management of side effects, counseling for 31
continued adherence, and device insertion and removal. 32
(b) A group or blanket policy subject to this section shall not impose a deductible, 33
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 34
LC001964 - Page 5 of 15
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 1
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 2
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 3
withdrawals from his or her health savings account under 26 U.S.C. § 223. A health plan shall not 4
impose utilization control or other forms of medical management limiting the supply of FDA-5
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 6
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 7
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 8
such coverage other than a pharmacy claim. 9
(c) Except as otherwise authorized under this section, a group or blanket policy shall not 10
impose any restrictions or delays on the coverage required under this section. 11
(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 12
spouse or domestic partner and covered non-spouse dependents. 13
(b)(e) Notwithstanding any other provision of this section, any hospital service corporation 14
may issue to a religious employer an individual or group health insurance contract, plan, or policy 15
that excludes coverage for prescription contraceptive methods that are contrary to the religious 16
employer’s bona fide religious tenets. The exclusion from coverage under this provision shall not 17
apply to contraceptive services or procedures provided for purposes other than contraception, such 18
as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. 19
(c)(f) As used in this section, “religious employer” means an employer that is a “church or 20
a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 21
(d)(g) Every religious employer that invokes the exemption provided under this section 22
shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 23
contraceptive healthcare services the employer refuses to cover for religious reasons. 24
(e)(h) Beginning on the first day of each plan year after April 1, 2019, every health 25
insurance issuer offering group or individual health insurance coverage that covers prescription 26
contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive 27
up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once 28
or over the course of the twelve (12) month period at the discretion of the prescriber. 29
(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 30
devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 31
ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 32
preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 33
accordance with § 27-19-38. The department may base its determinations on findings from onsite 34
LC001964 - Page 6 of 15
surveys, enrollee or other complaints, financial status, or any other source. 1
(j) The department shall monitor plan compliance in accordance with this section and shall 2
adopt rules for the implementation of this section, including the following: 3
(1) In addition to any requirements under state administrative procedures, the department 4
shall engage in a stakeholder process prior to the adoption of rules that include health care service 5
plans, pharmacy benefit plans, consumer representatives, including those representing youth, low-6
income people, and communities of color, and other interested parties. The department shall hold 7
stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider 8
factors and processes relevant to contraceptive coverage. The department shall provide notice of 9
stakeholder meetings on the department's website, and stakeholder meetings shall be open to the 10
public. 11
(2) The department shall conduct random reviews of each plan and its subcontractors to 12
ensure compliance with this section. 13
(3) The department shall submit an annual report to the general assembly and any other 14
appropriate entity with its findings from the random compliance reviews detailed in this section 15
and any other compliance or implementation efforts. This report shall be made available to the 16
public on the department’s website. 17
SECTION 3. Section 27-20-43 of the General Laws in Chapter 27-20 entitled "Nonprofit 18
Medical Service Corporations" is hereby amended to read as follows: 19
27-20-43. F.D.A. approved prescription contraceptive drugs and devices. 20
(a) Every individual or group health insurance contract, plan, or policy issued pursuant to 21
this title that provides prescription coverage and is delivered, issued for delivery, or renewed, 22
amended or effective in this state on or after January 1, 2024 shall provide coverage for F.D.A. 23
approved contraceptive drugs and devices requiring a prescription all of the following services and 24
contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or 25
require coverage for the prescription drug RU 486. 26
(1) All FDA-approved contraceptive drugs, devices, and other products. The following 27
applies to this coverage: 28
(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 29
product, the contract shall include either the original FDA-approved contraceptive drug device, or 30
product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same 31
definition as that set forth by the FDA; 32
(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 33
available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 34
LC001964 - Page 7 of 15
blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 1
contraceptive drug, device, or product, based on the determination of the health care provider, 2
without cost-sharing; 3
(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-4
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 5
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 6
management restrictions. 7
(2) Voluntary sterilization procedures; 8
(3) Clinical services related to the provision or use of contraception, including 9
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 10
education, referrals, and counseling; and 11
(4) Follow-up services related to the drugs, devices, products, and procedures covered 12
under this section, including, but not limited to, management of side effects, counseling for 13
continued adherence, and device insertion and removal. 14
(b) A group or blanket policy subject to this section shall not impose a deductible, 15
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 16
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 17
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 18
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 19
withdrawals from his or her health savings account under 26 U.S.C. § 223. A health plan shall not 20
impose utilization control or other forms of medical management limiting the supply of FDA-21
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 22
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 23
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 24
such coverage other than a pharmacy claim. 25
(c) Except as otherwise authorized under this section, a group or blanket policy shall not 26
impose any restrictions or delays on the coverage required under this section. 27
(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 28
spouse or domestic partner and covered non-spouse dependents. 29
(b)(e) Notwithstanding any other provision of this section, any medical service corporation 30
may issue to a religious employer an individual or group health insurance contract, plan, or policy 31
that excludes coverage for prescription contraceptive methods which are contrary to the religious 32
employer’s bona fide religious tenets. The exclusion from coverage under this provision shall not 33
apply to contraceptive services or procedures provided for purposes other than contraception, such 34
LC001964 - Page 8 of 15
as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. 1
(c)(f) As used in this section, “religious employer” means an employer that is a “church or 2
a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 3
(d)(g) Every religious employer that invokes the exemption provided under this section 4
shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 5
contraceptive healthcare services the employer refuses to cover for religious reasons. 6
(e)(h) Beginning on the first day of each plan year after April 1, 2019, every health 7
insurance issuer offering group or individual health insurance coverage that covers prescription 8
contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive 9
up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once 10
or over the course of the twelve (12) month period at the discretion of the prescriber. 11
(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 12
devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 13
ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 14
preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 15
accordance with § 27-20-33. The department may base its determinations on findings from onsite 16
surveys, enrollee or other complaints, financial status, or any other source. 17
(j) The department shall monitor plan compliance in accordance with this section and shall 18
adopt rules for the implementation of this section, including the following: 19
(1) In addition to any requirements under state administrative procedures, the department 20
shall engage in a stakeholder process prior to the adoption of rules that include health care service 21
plans, pharmacy benefit plans, consumer representatives, including those representing youth, low-22
income people, and communities of color, and other interested parties. The department shall hold 23
stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider 24
factors and processes relevant to contraceptive coverage. The department shall provide notice of 25
stakeholder meetings on the department's website, and stakeholder meetings shall be open to the 26
public. 27
(2) The department shall conduct random reviews of each plan and its subcontractors to 28
ensure compliance with this section. 29
(3) The department shall submit an annual report to the general assembly and any other 30
appropriate entity with its findings from the random compliance reviews detailed in this section 31
and any other compliance or implementation efforts. This report shall be made available to the 32
public on the department’s website. 33
SECTION 4. Section 27-41-59 of the General Laws in Chapter 27-41 entitled "Health 34
LC001964 - Page 9 of 15
Maintenance Organizations" is hereby amended to read as follows: 1
27-41-59. F.D.A. approved prescription contraceptive drugs and devices. 2
(a) Every individual or group health insurance contract, plan, or policy issued pursuant to 3
this title that provides prescription coverage and is delivered, issued for delivery, or renewed, 4
amended or effective in this state on or after January 1, 2024 shall provide coverage for F.D.A. 5
approved contraceptive drugs and devices requiring a prescription; provided, all of the following 6
services and contraceptive methods. Provided, that nothing in this subsection shall be deemed to 7
mandate or require coverage for the prescription drug RU 486. 8
(1) All FDA-approved contraceptive drugs, devices, and other products. The following 9
applies to this coverage: 10
(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 11
product, the contract shall include either the original FDA-approved contraceptive drug device, or 12
product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same 13
definition as that set forth by the FDA; 14
(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 15
available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 16
blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 17
contraceptive drug, device, or product, based on the determination of the health care provider, 18
without cost-sharing; 19
(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-20
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 21
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 22
management restrictions. 23
(2) Voluntary sterilization procedures; 24
(3) Clinical services related to the provision or use of contraception, including 25
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 26
education, referrals, and counseling; and 27
(4) Follow-up services related to the drugs, devices, products, and procedures covered 28
under this section, including, but not limited to, management of side effects, counseling for 29
continued adherence, and device insertion and removal. 30
(b) A group or blanket policy subject to this section shall not impose a deductible, 31
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 32
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 33
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 34
LC001964 - Page 10 of 15
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 1
withdrawals from his or her health savings account under 26 U.S.C. § 223. A health plan shall not 2
impose utilization control or other forms of medical management limiting the supply of FDA-3
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 4
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 5
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 6
such coverage other than a pharmacy claim. 7
(c) Except as otherwise authorized under this section, a group or blanket policy shall not 8
impose any restrictions or delays on the coverage required under this section. 9
(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 10
spouse or domestic partner and covered non-spouse dependents. 11
(b)(e) Notwithstanding any other provision of this section, any health maintenance 12
corporation may issue to a religious employer an individual or group health insurance contract, 13
plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to 14
the religious employer’s bona fide religious tenets. The exclusion from coverage under this 15
provision shall not apply to contraceptive services or procedures provided for purposes other than 16
contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of 17
menopause. 18
(c)(f) As used in this section, “religious employer” means an employer that is a “church or 19
a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 20
(d)(g) Every religious employer that invokes the exemption provided under this section 21
shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 22
contraceptive healthcare services the employer refuses to cover for religious reasons. 23
(e)(h) Beginning on the first day of each plan year after April 1, 2019, every health 24
insurance issuer offering group or individual health insurance coverage that covers prescription 25
contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive 26
up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once 27
or over the course of the twelve (12) month period at the discretion of the prescriber. 28
(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 29
devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 30
ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 31
preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 32
accordance with § 27-41-21. The department may base its determinations on findings from onsite 33
surveys, enrollee or other complaints, financial status, or any other source. 34
LC001964 - Page 11 of 15
(j) The department shall monitor plan compliance in accordance with this section and shall 1
adopt rules for the implementation of this section, including the following: 2
(1) In addition to any requirements under state administrative procedures, the department 3
shall engage in a stakeholder process prior to the adoption of rules that include health care service 4
plans, pharmacy benefit plans, consumer representatives, including those representing youth, low-5
income people, and communities of color, and other interested parties. The department shall hold 6
stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider 7
factors and processes relevant to contraceptive coverage. The department shall provide notice of 8
stakeholder meetings on the department's website, and stakeholder meetings shall be open to the 9
public. 10
(2) The department shall conduct random reviews of each plan and its subcontractors to 11
ensure compliance with this section. 12
(3) The department shall submit an annual report to the general assembly and any other 13
appropriate entity with its findings from the random compliance reviews detailed in this section 14
and any other compliance or implementation efforts. This report shall be made available to the 15
public on the department’s website. 16
SECTION 5. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby 17
amended by adding thereto the following section: 18
40-8-33. F.D.A.-approved prescription contraceptive drugs and devices. 19
(a) Every individual or group health insurance contract, plan, or policy issued pursuant to 20
this chapter that is delivered, issued for delivery, renewed, amended or effective in this state on or 21
after January 1, 2024 shall provide coverage for all of the following services and contraceptive 22
methods. Provided, that nothing in this subsection shall be deemed to mandate or require coverage 23
for the prescription drug RU 486. 24
(1) All FDA-approved contraceptive drugs, devices, and other products. The following 25
applies to this coverage: 26
(i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 27
product, the contract shall include either the original FDA-approved contraceptive drug device, or 28
product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same 29
definition as that set forth by the FDA; 30
(ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 31
available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 32
blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 33
contraceptive drug, device, or product, based on the determination of the health care provider, 34
LC001964 - Page 12 of 15
without cost-sharing; 1
(iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-2
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 3
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 4
management restrictions. 5
(2) Voluntary sterilization procedures; 6
(3) Clinical services related to the provision or use of contraception, including 7
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 8
education, referrals, and counseling; and 9
(4) Follow-up services related to the drugs, devices, products, and procedures covered 10
under this section, including, but not limited to, management of side effects, counseling for 11
continued adherence, and device insertion and removal. 12
(b) A group or blanket policy subject to this section shall not impose a deductible, 13
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 14
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 15
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 16
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 17
withdrawals from his or her health savings account under 26 U.S.C. § 223. A health plan shall not 18
impose utilization control or other forms of medical management limiting the supply of FDA-19
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 20
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 21
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 22
such coverage other than a pharmacy claim. 23
(c) Except as otherwise authorized under this section, a group or blanket policy shall not 24
impose any restrictions or delays on the coverage required under this section. 25
(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 26
spouse or domestic partner and covered non-spouse dependents. 27
(e) Notwithstanding any other provision of this section, any health maintenance 28
corporation may issue to a religious employer an individual or group health insurance contract, 29
plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to 30
the religious employer's bona fide religious tenets. The exclusion from coverage under this 31
provision shall not apply to contraceptive services or procedures provided for purposes other than 32
contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of 33
menopause. 34
LC001964 - Page 13 of 15
(f) As used in this section, "religious employer" means an employer that is a "church or a 1
qualified church-controlled organization" as defined in 26 U.S.C. § 3121. 2
(g) Every religious employer that invokes the exemption provided under this section shall 3
provide written notice to prospective enrollees prior to enrollment with the plan, listing the 4
contraceptive health care services the employer refuses to cover for religious reasons. 5
(h) Beginning on the first day of each plan year after April 1, 2023, every health insurance 6
issuer offering group or individual health insurance coverage that covers prescription contraception 7
shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three 8
hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the 9
course of the twelve (12) month period at the discretion of the prescriber. 10
(i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 11
devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 12
ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 13
preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, and 14
punished by a fine of not less than twenty dollars ($20.00) nor more than fifty dollars ($50.00). The 15
department may base its determinations on findings from onsite surveys, enrollee or other 16
complaints, financial status, or any other source. 17
(j) The department shall monitor plan compliance in accordance with this section and shall 18
adopt rules for the implementation of this section, including the following: 19
(1) In addition to any requirements under state administrative procedures, the department 20
shall engage in a stakeholder process prior to the adoption of rules that include health care service 21
plans, pharmacy benefit plans, consumer representatives, including those representing youth, low-22
income people, and communities of color, and other interested parties. The department shall hold 23
stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider 24
factors and processes relevant to contraceptive coverage. The department shall provide notice of 25
stakeholder meetings on the department's website, and stakeholder meetings shall be open to the 26
public. 27
(2) The department shall conduct random reviews of each plan and its subcontractors to 28
ensure compliance with this section. 29
(3) The department shall submit an annual report to the general assembly and any other 30
appropriate entity with its findings from the random compliance reviews detailed in this section 31
and any other compliance or implementation efforts. This report shall be made available to the 32
public on the department’s website. 33
LC001964 - Page 14 of 15
SECTION 6. This act shall take effect upon passage. 1
========
LC001964
========
LC001964 - Page 15 of 15
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
This act would require every individual or group health insurance contract effective on or 1
after January 1, 2024, to provide coverage to the insured and the insured's spouse and dependents 2
for all FDA-approved contraceptive drugs, devices and other products, voluntary sterilization 3
procedures, patient education and counseling on contraception and follow-up services as well as 4
Medicaid coverage for a twelve (12) month supply for Medicaid recipients. 5
This act would take effect upon passage. 6
========
LC001964
========