2025 -- H 6047
========
LC002275
========
S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2025
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Representatives Alzate, Kazarian, Caldwell, Shanley, Speakman, Ajello,
Felix, Tanzi, Casimiro, and Giraldo
Date Introduced: March 07, 2025
Referred To: House Finance
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, 2026, 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 healthcare provider, 19
LC002275 - Page 2 of 15
without cost-sharing; and 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 their 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 subsection 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
LC002275 - 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 and regulations 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 and regulations that include 23
healthcare service plans, pharmacy benefit plans, consumer representatives, including those 24
representing youth, low-income people, and communities of color, and other interested parties. The 25
department shall hold stakeholder meetings for stakeholders of different types to ensure sufficient 26
opportunity to consider factors and processes relevant to contraceptive coverage. The department 27
shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings 28
shall be open to the 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
LC002275 - 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. FDA 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, 2026, 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 healthcare provider, 20
without cost-sharing; and 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
LC002275 - 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 their 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 subsection 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
LC002275 - 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 and regulations 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 and regulations that include 5
healthcare service plans, pharmacy benefit plans, consumer representatives, including those 6
representing youth, low-income people, and communities of color, and other interested parties. The 7
department shall hold stakeholder meetings for stakeholders of different types to ensure sufficient 8
opportunity to consider factors and processes relevant to contraceptive coverage. The department 9
shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings 10
shall be open to the 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. FDA 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, 2026, 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; If the covered therapeutic equivalent versions of a drug, 32
device, or product are not available, or are not tolerated by the patient, or are deemed medically 33
inadvisable, a group or blanket policy shall provide coverage for an alternate therapeutic equivalent 34
LC002275 - Page 7 of 15
version of the contraceptive drug, device, or product, based on the determination of the healthcare 1
provider, without cost-sharing; and 2
(ii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-3
counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 4
over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 5
management restrictions; 6
(2) Voluntary sterilization procedures; 7
(3) Clinical services related to the provision or use of contraception, including 8
consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 9
education, referrals, and counseling; and 10
(4) Follow-up services related to the drugs, devices, products, and procedures covered 11
under this section, including, but not limited to, management of side effects, counseling for 12
continued adherence, and device insertion and removal. 13
(b) A group or blanket policy subject to this section shall not impose a deductible, 14
coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 15
to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 16
shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 17
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 18
withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 19
impose utilization control or other forms of medical management limiting the supply of FDA- 20
approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 21
location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 22
than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 23
such coverage other than a pharmacy claim. 24
(c) Except as otherwise authorized under this section, a group or blanket policy shall not 25
impose any restrictions or delays on the coverage required under this section. 26
(d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 27
spouse or domestic partner and covered non-spouse dependents. 28
(b)(e) Notwithstanding any other provision of this section, any medical service corporation 29
may issue to a religious employer an individual or group health insurance contract, plan, or policy 30
that excludes coverage for prescription contraceptive methods that are contrary to the religious 31
employer’s bona fide religious tenets. The exclusion from coverage under this subsection, shall not 32
apply to contraceptive services or procedures provided for purposes other than contraception, such 33
as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. 34
LC002275 - Page 8 of 15
(c)(f) As used in this section, “religious employer” means an employer that is a “church or 1
a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 2
(d)(g) Every religious employer that invokes the exemption provided under this section 3
shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 4
contraceptive healthcare services the employer refuses to cover for religious reasons. 5
(e)(h) Beginning on the first day of each plan year after April 1, 2019, every health 6
insurance issuer offering group or individual health insurance coverage that covers prescription 7
contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive 8
up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once 9
or over the 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, in 14
accordance with § 27-20-33. The department may base its determinations on findings from onsite 15
surveys, enrollee or other complaints, financial status, or any other source. 16
(j) The department shall monitor plan compliance in accordance with this section and shall 17
adopt rules and regulations for the implementation of this section, including the following: 18
(1) In addition to any requirements under state administrative procedures, the department 19
shall engage in a stakeholder process prior to the adoption of rules and regulations that include 20
healthcare service plans, pharmacy benefit plans, consumer representatives, including those 21
representing youth, low-income people, and communities of color, and other interested parties. The 22
department shall hold stakeholder meetings for stakeholders of different types to ensure sufficient 23
opportunity to consider factors and processes relevant to contraceptive coverage. The department 24
shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings 25
shall be open to the public. 26
(2) The department shall conduct random reviews of each plan and its subcontractors to 27
ensure compliance with this section. 28
(3) The department shall submit an annual report to the general assembly and any other 29
appropriate entity with its findings from the random compliance reviews detailed in this section 30
and any other compliance or implementation efforts. This report shall be made available to the 31
public on the department’s website. 32
SECTION 4. Section 27-41-59 of the General Laws in Chapter 27-41 entitled "Health 33
Maintenance Organizations" is hereby amended to read as follows: 34
LC002275 - Page 9 of 15
27-41-59. FDA approved prescription contraceptive drugs and devices. 1
(a) Every individual or group health insurance contract, plan, or policy issued pursuant to 2
this title that provides prescription coverage and is delivered, issued for delivery, or renewed, 3
amended, or effective in this state on or after January 1, 2026, shall provide coverage for FDA 4
approved contraceptive drugs and devices requiring a prescription; provided, all of the following 5
services and contraceptive methods. Provided all of the following services and contraceptive 6
methods. that nothing in this subsection shall be deemed to mandate or require coverage for the 7
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 healthcare provider, 18
without cost-sharing; and 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
LC002275 - Page 10 of 15
minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 1
withdrawals from their 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
subsection 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
LC002275 - Page 11 of 15
(j) The department shall monitor plan compliance in accordance with this section and shall 1
adopt rules and regulations 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 and regulations that include 4
healthcare service plans, pharmacy benefit plans, consumer representatives, including those 5
representing youth, low-income people, and communities of color, and other interested parties. The 6
department shall hold stakeholder meetings for stakeholders of different types to ensure sufficient 7
opportunity to consider factors and processes relevant to contraceptive coverage. The department 8
shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings 9
shall be open to the 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. FDA-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, 2026, 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 healthcare provider, 34
LC002275 - Page 12 of 15
without cost-sharing; and 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 their 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
subsection 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
LC002275 - 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 healthcare services the employer refuses to cover for religious reasons. 5
(h) Beginning on the first day of each plan year after April 1, 2024, 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, in 14
accordance with § 40-8-9. The department may base its determinations on findings from onsite 15
surveys, enrollee or other complaints, financial status, or any other source. 16
(j) The department shall monitor plan compliance in accordance with this section and shall 17
adopt and regulations rules for the implementation of this section, including the following: 18
(1) In addition to any requirements under state administrative procedures, the department 19
shall engage in a stakeholder process prior to the adoption of rules and regulations that include 20
healthcare service plans, pharmacy benefit plans, consumer representatives, including those 21
representing youth, low-income people, and communities of color, and other interested parties. The 22
department shall hold stakeholder meetings for stakeholders of different types to ensure sufficient 23
opportunity to consider factors and processes relevant to contraceptive coverage. The department 24
shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings 25
shall be open to the public. 26
(2) The department shall conduct random reviews of each plan and its subcontractors to 27
ensure compliance with this section. 28
(3) The department shall submit an annual report to the general assembly and any other 29
appropriate entity with its findings from the random compliance reviews detailed in this section 30
and any other compliance or implementation efforts. This report shall be made available to the 31
public on the department’s website. 32
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SECTION 6. This act shall take effect upon passage. 1
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LC002275 - 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, 2026, 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
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