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| 4 | 4 | | |
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| 5 | 5 | | 2025 -- H 6047 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC002275 |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S T A T E O F R H O D E I S L A N D |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2025 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES |
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| 16 | 16 | | Introduced By: Representatives Alzate, Kazarian, Caldwell, Shanley, Speakman, Ajello, |
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| 17 | 17 | | Felix, Tanzi, Casimiro, and Giraldo |
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| 18 | 18 | | Date Introduced: March 07, 2025 |
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| 19 | 19 | | Referred To: House Finance |
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| 20 | 20 | | |
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| 21 | 21 | | |
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| 22 | 22 | | It is enacted by the General Assembly as follows: |
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| 23 | 23 | | SECTION 1. Section 27-18-57 of the General Laws in Chapter 27-18 entitled "Accident 1 |
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| 24 | 24 | | and Sickness Insurance Policies" is hereby amended to read as follows: 2 |
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| 25 | 25 | | 27-18-57. F.D.A. approved prescription contraceptive drugs and devices. 3 |
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| 26 | 26 | | (a) Every individual or group health insurance contract, plan, or policy issued pursuant to 4 |
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| 27 | 27 | | this title that provides prescription coverage and is delivered, issued for delivery, or renewed, 5 |
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| 28 | 28 | | amended, or effective in this state on or after January 1, 2026, shall provide coverage for F.D.A. 6 |
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| 29 | 29 | | approved contraceptive drugs and devices requiring a prescription all of the following services and 7 |
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| 30 | 30 | | contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or 8 |
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| 31 | 31 | | require coverage for the prescription drug RU 486. 9 |
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| 32 | 32 | | (1) All FDA-approved contraceptive drugs, devices, and other products. The following 10 |
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| 33 | 33 | | applies to this coverage: 11 |
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| 34 | 34 | | (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 12 |
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| 35 | 35 | | product, the contract shall include either the original FDA-approved contraceptive drug, device, or 13 |
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| 36 | 36 | | product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same 14 |
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| 37 | 37 | | definition as that set forth by the FDA; 15 |
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| 38 | 38 | | (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 16 |
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| 39 | 39 | | available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 17 |
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| 40 | 40 | | blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 18 |
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| 41 | 41 | | contraceptive drug, device, or product, based on the determination of the healthcare provider, 19 |
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| 42 | 42 | | |
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| 43 | 43 | | |
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| 44 | 44 | | LC002275 - Page 2 of 15 |
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| 45 | 45 | | without cost-sharing; and 1 |
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| 46 | 46 | | (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- 2 |
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| 47 | 47 | | counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 3 |
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| 48 | 48 | | over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 4 |
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| 49 | 49 | | management restrictions; 5 |
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| 50 | 50 | | (2) Voluntary sterilization procedures; 6 |
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| 51 | 51 | | (3) Clinical services related to the provision or use of contraception, including 7 |
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| 52 | 52 | | consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 8 |
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| 53 | 53 | | education, referrals, and counseling; and 9 |
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| 54 | 54 | | (4) Follow-up services related to the drugs, devices, products, and procedures covered 10 |
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| 55 | 55 | | under this section, including, but not limited to, management of side effects, counseling for 11 |
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| 56 | 56 | | continued adherence, and device insertion and removal. 12 |
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| 57 | 57 | | (b) A group or blanket policy subject to this section shall not impose a deductible, 13 |
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| 58 | 58 | | coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 14 |
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| 59 | 59 | | to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 15 |
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| 60 | 60 | | shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 16 |
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| 61 | 61 | | minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 17 |
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| 62 | 62 | | withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 18 |
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| 63 | 63 | | impose utilization control or other forms of medical management limiting the supply of FDA-19 |
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| 64 | 64 | | approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 20 |
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| 65 | 65 | | location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 21 |
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| 66 | 66 | | than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 22 |
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| 67 | 67 | | such coverage other than a pharmacy claim. 23 |
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| 68 | 68 | | (c) Except as otherwise authorized under this section, a group or blanket policy shall not 24 |
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| 69 | 69 | | impose any restrictions or delays on the coverage required under this section. 25 |
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| 70 | 70 | | (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 26 |
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| 71 | 71 | | spouse or domestic partner and covered non-spouse dependents 27 |
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| 72 | 72 | | (b)(e) Notwithstanding any other provision of this section, any insurance company may 28 |
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| 73 | 73 | | issue to a religious employer an individual or group health insurance contract, plan, or policy that 29 |
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| 74 | 74 | | excludes coverage for prescription contraceptive methods that are contrary to the religious 30 |
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| 75 | 75 | | employer’s bona fide religious tenets. The exclusion from coverage under this subsection shall not 31 |
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| 76 | 76 | | apply to contraceptive services or procedures provided for purposes other than contraception, such 32 |
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| 77 | 77 | | as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. 33 |
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| 78 | 78 | | (c)(f) As used in this section, “religious employer” means an employer that is a “church or 34 |
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| 79 | 79 | | |
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| 80 | 80 | | |
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| 81 | 81 | | LC002275 - Page 3 of 15 |
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| 82 | 82 | | a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 1 |
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| 83 | 83 | | (d)(g) This section does not apply to insurance coverage providing benefits for: (1) Hospital 2 |
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| 84 | 84 | | confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare 3 |
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| 85 | 85 | | supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily 4 |
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| 86 | 86 | | injury or death by accident or both; and (9) Other limited-benefit policies. 5 |
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| 87 | 87 | | (e)(h) Every religious employer that invokes the exemption provided under this section 6 |
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| 88 | 88 | | shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 7 |
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| 89 | 89 | | contraceptive healthcare services the employer refuses to cover for religious reasons. 8 |
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| 90 | 90 | | (f)(i) Beginning on the first day of each plan year after April 1, 2019, every health insurance 9 |
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| 91 | 91 | | issuer offering group or individual health insurance coverage that covers prescription contraception 10 |
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| 92 | 92 | | shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three 11 |
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| 93 | 93 | | hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the 12 |
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| 94 | 94 | | course of the twelve (12) month period at the discretion of the prescriber. 13 |
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| 95 | 95 | | (j) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 14 |
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| 96 | 96 | | devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 15 |
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| 97 | 97 | | ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 16 |
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| 98 | 98 | | preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 17 |
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| 99 | 99 | | accordance with § 27-18-20. The department may base its determinations on findings from onsite 18 |
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| 100 | 100 | | surveys, enrollee or other complaints, financial status, or any other source. 19 |
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| 101 | 101 | | (k) The department shall monitor plan compliance in accordance with this section and shall 20 |
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| 102 | 102 | | adopt rules and regulations for the implementation of this section, including the following: 21 |
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| 103 | 103 | | (1) In addition to any requirements under state administrative procedures, the department 22 |
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| 104 | 104 | | shall engage in a stakeholder process prior to the adoption of rules and regulations that include 23 |
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| 105 | 105 | | healthcare service plans, pharmacy benefit plans, consumer representatives, including those 24 |
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| 106 | 106 | | representing youth, low-income people, and communities of color, and other interested parties. The 25 |
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| 107 | 107 | | department shall hold stakeholder meetings for stakeholders of different types to ensure sufficient 26 |
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| 108 | 108 | | opportunity to consider factors and processes relevant to contraceptive coverage. The department 27 |
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| 109 | 109 | | shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings 28 |
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| 110 | 110 | | shall be open to the public. 29 |
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| 111 | 111 | | (2) The department shall conduct random reviews of each plan and its subcontractors to 30 |
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| 112 | 112 | | ensure compliance with this section. 31 |
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| 113 | 113 | | (3) The department shall submit an annual report to the general assembly and any other 32 |
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| 114 | 114 | | appropriate entity with its findings from the random compliance reviews detailed in this section 33 |
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| 115 | 115 | | and any other compliance or implementation efforts. This report shall be made available to the 34 |
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| 116 | 116 | | |
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| 117 | 117 | | |
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| 118 | 118 | | LC002275 - Page 4 of 15 |
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| 119 | 119 | | public on the department’s website. 1 |
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| 120 | 120 | | SECTION 2. Section 27-19-48 of the General Laws in Chapter 27-19 entitled "Nonprofit 2 |
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| 121 | 121 | | Hospital Service Corporations" is hereby amended to read as follows: 3 |
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| 122 | 122 | | 27-19-48. FDA approved prescription contraceptive drugs and devices. 4 |
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| 123 | 123 | | (a) Every individual or group health insurance contract, plan, or policy issued pursuant to 5 |
|---|
| 124 | 124 | | this title that provides prescription coverage and is delivered, issued for delivery, or renewed, 6 |
|---|
| 125 | 125 | | amended, or effective in this state on or after January 1, 2026, shall provide coverage for F.D.A. 7 |
|---|
| 126 | 126 | | approved contraceptive drugs and devices requiring a prescription all of the following services and 8 |
|---|
| 127 | 127 | | contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or 9 |
|---|
| 128 | 128 | | require coverage for the prescription drug RU 486. 10 |
|---|
| 129 | 129 | | (1) All FDA-approved contraceptive drugs, devices, and other products. The following 11 |
|---|
| 130 | 130 | | applies to this coverage: 12 |
|---|
| 131 | 131 | | (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 13 |
|---|
| 132 | 132 | | product, the contract shall include either the original FDA-approved contraceptive drug, device, or 14 |
|---|
| 133 | 133 | | product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same 15 |
|---|
| 134 | 134 | | definition as that set forth by the FDA; 16 |
|---|
| 135 | 135 | | (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 17 |
|---|
| 136 | 136 | | available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 18 |
|---|
| 137 | 137 | | blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 19 |
|---|
| 138 | 138 | | contraceptive drug, device, or product, based on the determination of the healthcare provider, 20 |
|---|
| 139 | 139 | | without cost-sharing; and 21 |
|---|
| 140 | 140 | | (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-22 |
|---|
| 141 | 141 | | counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 23 |
|---|
| 142 | 142 | | over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 24 |
|---|
| 143 | 143 | | management restrictions; 25 |
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| 144 | 144 | | (2) Voluntary sterilization procedures; 26 |
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| 145 | 145 | | (3) Clinical services related to the provision or use of contraception, including 27 |
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| 146 | 146 | | consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 28 |
|---|
| 147 | 147 | | education, referrals, and counseling; and 29 |
|---|
| 148 | 148 | | (4) Follow-up services related to the drugs, devices, products, and procedures covered 30 |
|---|
| 149 | 149 | | under this section, including, but not limited to, management of side effects, counseling for 31 |
|---|
| 150 | 150 | | continued adherence, and device insertion and removal. 32 |
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| 151 | 151 | | (b) A group or blanket policy subject to this section shall not impose a deductible, 33 |
|---|
| 152 | 152 | | coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 34 |
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| 153 | 153 | | |
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| 154 | 154 | | |
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| 155 | 155 | | LC002275 - Page 5 of 15 |
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| 156 | 156 | | to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 1 |
|---|
| 157 | 157 | | shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 2 |
|---|
| 158 | 158 | | minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 3 |
|---|
| 159 | 159 | | withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 4 |
|---|
| 160 | 160 | | impose utilization control or other forms of medical management limiting the supply of FDA-5 |
|---|
| 161 | 161 | | approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 6 |
|---|
| 162 | 162 | | location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 7 |
|---|
| 163 | 163 | | than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 8 |
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| 164 | 164 | | such coverage other than a pharmacy claim. 9 |
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| 165 | 165 | | (c) Except as otherwise authorized under this section, a group or blanket policy shall not 10 |
|---|
| 166 | 166 | | impose any restrictions or delays on the coverage required under this section. 11 |
|---|
| 167 | 167 | | (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 12 |
|---|
| 168 | 168 | | spouse or domestic partner and covered non-spouse dependents. 13 |
|---|
| 169 | 169 | | (b)(e) Notwithstanding any other provision of this section, any hospital service corporation 14 |
|---|
| 170 | 170 | | may issue to a religious employer an individual or group health insurance contract, plan, or policy 15 |
|---|
| 171 | 171 | | that excludes coverage for prescription contraceptive methods that are contrary to the religious 16 |
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| 172 | 172 | | employer’s bona fide religious tenets. The exclusion from coverage under this subsection shall not 17 |
|---|
| 173 | 173 | | apply to contraceptive services or procedures provided for purposes other than contraception, such 18 |
|---|
| 174 | 174 | | as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. 19 |
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| 175 | 175 | | (c)(f) As used in this section, “religious employer” means an employer that is a “church or 20 |
|---|
| 176 | 176 | | a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 21 |
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| 177 | 177 | | (d)(g) Every religious employer that invokes the exemption provided under this section 22 |
|---|
| 178 | 178 | | shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 23 |
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| 179 | 179 | | contraceptive healthcare services the employer refuses to cover for religious reasons. 24 |
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| 180 | 180 | | (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health 25 |
|---|
| 181 | 181 | | insurance issuer offering group or individual health insurance coverage that covers prescription 26 |
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| 182 | 182 | | contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive 27 |
|---|
| 183 | 183 | | up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once 28 |
|---|
| 184 | 184 | | or over the course of the twelve (12) month period at the discretion of the prescriber. 29 |
|---|
| 185 | 185 | | (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 30 |
|---|
| 186 | 186 | | devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 31 |
|---|
| 187 | 187 | | ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 32 |
|---|
| 188 | 188 | | preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 33 |
|---|
| 189 | 189 | | accordance with § 27-19-38. The department may base its determinations on findings from onsite 34 |
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| 190 | 190 | | |
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| 191 | 191 | | |
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| 192 | 192 | | LC002275 - Page 6 of 15 |
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| 193 | 193 | | surveys, enrollee or other complaints, financial status, or any other source. 1 |
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| 194 | 194 | | (j) The department shall monitor plan compliance in accordance with this section and shall 2 |
|---|
| 195 | 195 | | adopt rules and regulations for the implementation of this section, including the following: 3 |
|---|
| 196 | 196 | | (1) In addition to any requirements under state administrative procedures, the department 4 |
|---|
| 197 | 197 | | shall engage in a stakeholder process prior to the adoption of rules and regulations that include 5 |
|---|
| 198 | 198 | | healthcare service plans, pharmacy benefit plans, consumer representatives, including those 6 |
|---|
| 199 | 199 | | representing youth, low-income people, and communities of color, and other interested parties. The 7 |
|---|
| 200 | 200 | | department shall hold stakeholder meetings for stakeholders of different types to ensure sufficient 8 |
|---|
| 201 | 201 | | opportunity to consider factors and processes relevant to contraceptive coverage. The department 9 |
|---|
| 202 | 202 | | shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings 10 |
|---|
| 203 | 203 | | shall be open to the public. 11 |
|---|
| 204 | 204 | | (2) The department shall conduct random reviews of each plan and its subcontractors to 12 |
|---|
| 205 | 205 | | ensure compliance with this section. 13 |
|---|
| 206 | 206 | | (3) The department shall submit an annual report to the general assembly and any other 14 |
|---|
| 207 | 207 | | appropriate entity with its findings from the random compliance reviews detailed in this section 15 |
|---|
| 208 | 208 | | and any other compliance or implementation efforts. This report shall be made available to the 16 |
|---|
| 209 | 209 | | public on the department’s website. 17 |
|---|
| 210 | 210 | | SECTION 3. Section 27-20-43 of the General Laws in Chapter 27-20 entitled "Nonprofit 18 |
|---|
| 211 | 211 | | Medical Service Corporations" is hereby amended to read as follows: 19 |
|---|
| 212 | 212 | | 27-20-43. FDA approved prescription contraceptive drugs and devices. 20 |
|---|
| 213 | 213 | | (a) Every individual or group health insurance contract, plan, or policy issued pursuant to 21 |
|---|
| 214 | 214 | | this title that provides prescription coverage and is delivered, issued for delivery, or renewed, 22 |
|---|
| 215 | 215 | | amended, or effective in this state on or after January 1, 2026, shall provide coverage for F.D.A. 23 |
|---|
| 216 | 216 | | approved contraceptive drugs and devices requiring a prescription all of the following services and 24 |
|---|
| 217 | 217 | | contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or 25 |
|---|
| 218 | 218 | | require coverage for the prescription drug RU 486. 26 |
|---|
| 219 | 219 | | (1) All FDA-approved contraceptive drugs, devices and other products. The following 27 |
|---|
| 220 | 220 | | applies to this coverage: 28 |
|---|
| 221 | 221 | | (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 29 |
|---|
| 222 | 222 | | product, the contract shall include either the original FDA-approved contraceptive drug, device, or 30 |
|---|
| 223 | 223 | | product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same 31 |
|---|
| 224 | 224 | | definition as that set forth by the FDA; If the covered therapeutic equivalent versions of a drug, 32 |
|---|
| 225 | 225 | | device, or product are not available, or are not tolerated by the patient, or are deemed medically 33 |
|---|
| 226 | 226 | | inadvisable, a group or blanket policy shall provide coverage for an alternate therapeutic equivalent 34 |
|---|
| 227 | 227 | | |
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| 228 | 228 | | |
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| 229 | 229 | | LC002275 - Page 7 of 15 |
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| 230 | 230 | | version of the contraceptive drug, device, or product, based on the determination of the healthcare 1 |
|---|
| 231 | 231 | | provider, without cost-sharing; and 2 |
|---|
| 232 | 232 | | (ii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-3 |
|---|
| 233 | 233 | | counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 4 |
|---|
| 234 | 234 | | over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 5 |
|---|
| 235 | 235 | | management restrictions; 6 |
|---|
| 236 | 236 | | (2) Voluntary sterilization procedures; 7 |
|---|
| 237 | 237 | | (3) Clinical services related to the provision or use of contraception, including 8 |
|---|
| 238 | 238 | | consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 9 |
|---|
| 239 | 239 | | education, referrals, and counseling; and 10 |
|---|
| 240 | 240 | | (4) Follow-up services related to the drugs, devices, products, and procedures covered 11 |
|---|
| 241 | 241 | | under this section, including, but not limited to, management of side effects, counseling for 12 |
|---|
| 242 | 242 | | continued adherence, and device insertion and removal. 13 |
|---|
| 243 | 243 | | (b) A group or blanket policy subject to this section shall not impose a deductible, 14 |
|---|
| 244 | 244 | | coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 15 |
|---|
| 245 | 245 | | to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 16 |
|---|
| 246 | 246 | | shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 17 |
|---|
| 247 | 247 | | minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 18 |
|---|
| 248 | 248 | | withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 19 |
|---|
| 249 | 249 | | impose utilization control or other forms of medical management limiting the supply of FDA- 20 |
|---|
| 250 | 250 | | approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 21 |
|---|
| 251 | 251 | | location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 22 |
|---|
| 252 | 252 | | than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 23 |
|---|
| 253 | 253 | | such coverage other than a pharmacy claim. 24 |
|---|
| 254 | 254 | | (c) Except as otherwise authorized under this section, a group or blanket policy shall not 25 |
|---|
| 255 | 255 | | impose any restrictions or delays on the coverage required under this section. 26 |
|---|
| 256 | 256 | | (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 27 |
|---|
| 257 | 257 | | spouse or domestic partner and covered non-spouse dependents. 28 |
|---|
| 258 | 258 | | (b)(e) Notwithstanding any other provision of this section, any medical service corporation 29 |
|---|
| 259 | 259 | | may issue to a religious employer an individual or group health insurance contract, plan, or policy 30 |
|---|
| 260 | 260 | | that excludes coverage for prescription contraceptive methods that are contrary to the religious 31 |
|---|
| 261 | 261 | | employer’s bona fide religious tenets. The exclusion from coverage under this subsection, shall not 32 |
|---|
| 262 | 262 | | apply to contraceptive services or procedures provided for purposes other than contraception, such 33 |
|---|
| 263 | 263 | | as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. 34 |
|---|
| 264 | 264 | | |
|---|
| 265 | 265 | | |
|---|
| 266 | 266 | | LC002275 - Page 8 of 15 |
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| 267 | 267 | | (c)(f) As used in this section, “religious employer” means an employer that is a “church or 1 |
|---|
| 268 | 268 | | a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 2 |
|---|
| 269 | 269 | | (d)(g) Every religious employer that invokes the exemption provided under this section 3 |
|---|
| 270 | 270 | | shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 4 |
|---|
| 271 | 271 | | contraceptive healthcare services the employer refuses to cover for religious reasons. 5 |
|---|
| 272 | 272 | | (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health 6 |
|---|
| 273 | 273 | | insurance issuer offering group or individual health insurance coverage that covers prescription 7 |
|---|
| 274 | 274 | | contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive 8 |
|---|
| 275 | 275 | | up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once 9 |
|---|
| 276 | 276 | | or over the course of the twelve (12) month period at the discretion of the prescriber. 10 |
|---|
| 277 | 277 | | (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 11 |
|---|
| 278 | 278 | | devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 12 |
|---|
| 279 | 279 | | ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 13 |
|---|
| 280 | 280 | | preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 14 |
|---|
| 281 | 281 | | accordance with § 27-20-33. The department may base its determinations on findings from onsite 15 |
|---|
| 282 | 282 | | surveys, enrollee or other complaints, financial status, or any other source. 16 |
|---|
| 283 | 283 | | (j) The department shall monitor plan compliance in accordance with this section and shall 17 |
|---|
| 284 | 284 | | adopt rules and regulations for the implementation of this section, including the following: 18 |
|---|
| 285 | 285 | | (1) In addition to any requirements under state administrative procedures, the department 19 |
|---|
| 286 | 286 | | shall engage in a stakeholder process prior to the adoption of rules and regulations that include 20 |
|---|
| 287 | 287 | | healthcare service plans, pharmacy benefit plans, consumer representatives, including those 21 |
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| 288 | 288 | | representing youth, low-income people, and communities of color, and other interested parties. The 22 |
|---|
| 289 | 289 | | department shall hold stakeholder meetings for stakeholders of different types to ensure sufficient 23 |
|---|
| 290 | 290 | | opportunity to consider factors and processes relevant to contraceptive coverage. The department 24 |
|---|
| 291 | 291 | | shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings 25 |
|---|
| 292 | 292 | | shall be open to the public. 26 |
|---|
| 293 | 293 | | (2) The department shall conduct random reviews of each plan and its subcontractors to 27 |
|---|
| 294 | 294 | | ensure compliance with this section. 28 |
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| 295 | 295 | | (3) The department shall submit an annual report to the general assembly and any other 29 |
|---|
| 296 | 296 | | appropriate entity with its findings from the random compliance reviews detailed in this section 30 |
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| 297 | 297 | | and any other compliance or implementation efforts. This report shall be made available to the 31 |
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| 298 | 298 | | public on the department’s website. 32 |
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| 299 | 299 | | SECTION 4. Section 27-41-59 of the General Laws in Chapter 27-41 entitled "Health 33 |
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| 300 | 300 | | Maintenance Organizations" is hereby amended to read as follows: 34 |
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| 301 | 301 | | |
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| 302 | 302 | | |
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| 303 | 303 | | LC002275 - Page 9 of 15 |
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| 304 | 304 | | 27-41-59. FDA approved prescription contraceptive drugs and devices. 1 |
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| 305 | 305 | | (a) Every individual or group health insurance contract, plan, or policy issued pursuant to 2 |
|---|
| 306 | 306 | | this title that provides prescription coverage and is delivered, issued for delivery, or renewed, 3 |
|---|
| 307 | 307 | | amended, or effective in this state on or after January 1, 2026, shall provide coverage for FDA 4 |
|---|
| 308 | 308 | | approved contraceptive drugs and devices requiring a prescription; provided, all of the following 5 |
|---|
| 309 | 309 | | services and contraceptive methods. Provided all of the following services and contraceptive 6 |
|---|
| 310 | 310 | | methods. that nothing in this subsection shall be deemed to mandate or require coverage for the 7 |
|---|
| 311 | 311 | | prescription drug RU 486. 8 |
|---|
| 312 | 312 | | (1) All FDA-approved contraceptive drugs, devices, and other products. The following 9 |
|---|
| 313 | 313 | | applies to this coverage: 10 |
|---|
| 314 | 314 | | (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 11 |
|---|
| 315 | 315 | | product, the contract shall include either the original FDA-approved contraceptive drug, device, or 12 |
|---|
| 316 | 316 | | product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same 13 |
|---|
| 317 | 317 | | definition as that set forth by the FDA; 14 |
|---|
| 318 | 318 | | (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 15 |
|---|
| 319 | 319 | | available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 16 |
|---|
| 320 | 320 | | blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 17 |
|---|
| 321 | 321 | | contraceptive drug, device, or product, based on the determination of the healthcare provider, 18 |
|---|
| 322 | 322 | | without cost-sharing; and 19 |
|---|
| 323 | 323 | | (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-20 |
|---|
| 324 | 324 | | counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 21 |
|---|
| 325 | 325 | | over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 22 |
|---|
| 326 | 326 | | management restrictions; 23 |
|---|
| 327 | 327 | | (2) Voluntary sterilization procedures; 24 |
|---|
| 328 | 328 | | (3) Clinical services related to the provision or use of contraception, including 25 |
|---|
| 329 | 329 | | consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 26 |
|---|
| 330 | 330 | | education, referrals, and counseling; and 27 |
|---|
| 331 | 331 | | (4) Follow-up services related to the drugs, devices, products, and procedures covered 28 |
|---|
| 332 | 332 | | under this section, including, but not limited to, management of side effects, counseling for 29 |
|---|
| 333 | 333 | | continued adherence, and device insertion and removal. 30 |
|---|
| 334 | 334 | | (b) A group or blanket policy subject to this section shall not impose a deductible, 31 |
|---|
| 335 | 335 | | coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 32 |
|---|
| 336 | 336 | | to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 33 |
|---|
| 337 | 337 | | shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 34 |
|---|
| 338 | 338 | | |
|---|
| 339 | 339 | | |
|---|
| 340 | 340 | | LC002275 - Page 10 of 15 |
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| 341 | 341 | | minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 1 |
|---|
| 342 | 342 | | withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 2 |
|---|
| 343 | 343 | | impose utilization control or other forms of medical management limiting the supply of FDA-3 |
|---|
| 344 | 344 | | approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 4 |
|---|
| 345 | 345 | | location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 5 |
|---|
| 346 | 346 | | than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 6 |
|---|
| 347 | 347 | | such coverage other than a pharmacy claim. 7 |
|---|
| 348 | 348 | | (c) Except as otherwise authorized under this section, a group or blanket policy shall not 8 |
|---|
| 349 | 349 | | impose any restrictions or delays on the coverage required under this section. 9 |
|---|
| 350 | 350 | | (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 10 |
|---|
| 351 | 351 | | spouse or domestic partner and covered non-spouse dependents. 11 |
|---|
| 352 | 352 | | (b)(e) Notwithstanding any other provision of this section, any health maintenance 12 |
|---|
| 353 | 353 | | corporation may issue to a religious employer an individual or group health insurance contract, 13 |
|---|
| 354 | 354 | | plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to 14 |
|---|
| 355 | 355 | | the religious employer’s bona fide religious tenets. The exclusion from coverage under this 15 |
|---|
| 356 | 356 | | subsection shall not apply to contraceptive services or procedures provided for purposes other than 16 |
|---|
| 357 | 357 | | contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of 17 |
|---|
| 358 | 358 | | menopause. 18 |
|---|
| 359 | 359 | | (c)(f) As used in this section, “religious employer” means an employer that is a “church or 19 |
|---|
| 360 | 360 | | a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 20 |
|---|
| 361 | 361 | | (d)(g) Every religious employer that invokes the exemption provided under this section 21 |
|---|
| 362 | 362 | | shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 22 |
|---|
| 363 | 363 | | contraceptive healthcare services the employer refuses to cover for religious reasons. 23 |
|---|
| 364 | 364 | | (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health 24 |
|---|
| 365 | 365 | | insurance issuer offering group or individual health insurance coverage that covers prescription 25 |
|---|
| 366 | 366 | | contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive 26 |
|---|
| 367 | 367 | | up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once 27 |
|---|
| 368 | 368 | | or over the course of the twelve (12) month period at the discretion of the prescriber. 28 |
|---|
| 369 | 369 | | (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 29 |
|---|
| 370 | 370 | | devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 30 |
|---|
| 371 | 371 | | ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 31 |
|---|
| 372 | 372 | | preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 32 |
|---|
| 373 | 373 | | accordance with § 27-41-21. The department may base its determinations on findings from onsite 33 |
|---|
| 374 | 374 | | surveys, enrollee or other complaints, financial status, or any other source. 34 |
|---|
| 375 | 375 | | |
|---|
| 376 | 376 | | |
|---|
| 377 | 377 | | LC002275 - Page 11 of 15 |
|---|
| 378 | 378 | | (j) The department shall monitor plan compliance in accordance with this section and shall 1 |
|---|
| 379 | 379 | | adopt rules and regulations for the implementation of this section, including the following: 2 |
|---|
| 380 | 380 | | (1) In addition to any requirements under state administrative procedures, the department 3 |
|---|
| 381 | 381 | | shall engage in a stakeholder process prior to the adoption of rules and regulations that include 4 |
|---|
| 382 | 382 | | healthcare service plans, pharmacy benefit plans, consumer representatives, including those 5 |
|---|
| 383 | 383 | | representing youth, low-income people, and communities of color, and other interested parties. The 6 |
|---|
| 384 | 384 | | department shall hold stakeholder meetings for stakeholders of different types to ensure sufficient 7 |
|---|
| 385 | 385 | | opportunity to consider factors and processes relevant to contraceptive coverage. The department 8 |
|---|
| 386 | 386 | | shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings 9 |
|---|
| 387 | 387 | | shall be open to the public. 10 |
|---|
| 388 | 388 | | (2) The department shall conduct random reviews of each plan and its subcontractors to 11 |
|---|
| 389 | 389 | | ensure compliance with this section. 12 |
|---|
| 390 | 390 | | (3) The department shall submit an annual report to the general assembly and any other 13 |
|---|
| 391 | 391 | | appropriate entity with its findings from the random compliance reviews detailed in this section 14 |
|---|
| 392 | 392 | | and any other compliance or implementation efforts. This report shall be made available to the 15 |
|---|
| 393 | 393 | | public on the department’s website. 16 |
|---|
| 394 | 394 | | SECTION 5. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby 17 |
|---|
| 395 | 395 | | amended by adding thereto the following section: 18 |
|---|
| 396 | 396 | | 40-8-33. FDA-approved prescription contraceptive drugs and devices. 19 |
|---|
| 397 | 397 | | (a) Every individual or group health insurance contract, plan, or policy issued pursuant to 20 |
|---|
| 398 | 398 | | this chapter that is delivered, issued for delivery, renewed, amended or effective in this state on or 21 |
|---|
| 399 | 399 | | after January 1, 2026, shall provide coverage for all of the following services and contraceptive 22 |
|---|
| 400 | 400 | | methods. Provided, that nothing in this subsection shall be deemed to mandate or require coverage 23 |
|---|
| 401 | 401 | | for the prescription drug RU 486. 24 |
|---|
| 402 | 402 | | (1) All FDA-approved contraceptive drugs, devices, and other products. The following 25 |
|---|
| 403 | 403 | | applies to this coverage: 26 |
|---|
| 404 | 404 | | (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 27 |
|---|
| 405 | 405 | | product, the contract shall include either the original FDA-approved contraceptive drug, device, or 28 |
|---|
| 406 | 406 | | product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same 29 |
|---|
| 407 | 407 | | definition as that set forth by the FDA; 30 |
|---|
| 408 | 408 | | (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 31 |
|---|
| 409 | 409 | | available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 32 |
|---|
| 410 | 410 | | blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 33 |
|---|
| 411 | 411 | | contraceptive drug, device, or product, based on the determination of the healthcare provider, 34 |
|---|
| 412 | 412 | | |
|---|
| 413 | 413 | | |
|---|
| 414 | 414 | | LC002275 - Page 12 of 15 |
|---|
| 415 | 415 | | without cost-sharing; and 1 |
|---|
| 416 | 416 | | (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- 2 |
|---|
| 417 | 417 | | counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 3 |
|---|
| 418 | 418 | | over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 4 |
|---|
| 419 | 419 | | management restrictions; 5 |
|---|
| 420 | 420 | | (2) Voluntary sterilization procedures; 6 |
|---|
| 421 | 421 | | (3) Clinical services related to the provision or use of contraception, including 7 |
|---|
| 422 | 422 | | consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 8 |
|---|
| 423 | 423 | | education, referrals, and counseling; and 9 |
|---|
| 424 | 424 | | (4) Follow-up services related to the drugs, devices, products, and procedures covered 10 |
|---|
| 425 | 425 | | under this section, including, but not limited to, management of side effects, counseling for 11 |
|---|
| 426 | 426 | | continued adherence, and device insertion and removal. 12 |
|---|
| 427 | 427 | | (b) A group or blanket policy subject to this section shall not impose a deductible, 13 |
|---|
| 428 | 428 | | coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 14 |
|---|
| 429 | 429 | | to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 15 |
|---|
| 430 | 430 | | shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the 16 |
|---|
| 431 | 431 | | minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and 17 |
|---|
| 432 | 432 | | withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 18 |
|---|
| 433 | 433 | | impose utilization control or other forms of medical management limiting the supply of FDA-19 |
|---|
| 434 | 434 | | approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 20 |
|---|
| 435 | 435 | | location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 21 |
|---|
| 436 | 436 | | than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 22 |
|---|
| 437 | 437 | | such coverage other than a pharmacy claim. 23 |
|---|
| 438 | 438 | | (c) Except as otherwise authorized under this section, a group or blanket policy shall not 24 |
|---|
| 439 | 439 | | impose any restrictions or delays on the coverage required under this section. 25 |
|---|
| 440 | 440 | | (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered 26 |
|---|
| 441 | 441 | | spouse or domestic partner and covered non-spouse dependents. 27 |
|---|
| 442 | 442 | | (e) Notwithstanding any other provision of this section, any health maintenance 28 |
|---|
| 443 | 443 | | corporation may issue to a religious employer an individual or group health insurance contract, 29 |
|---|
| 444 | 444 | | plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to 30 |
|---|
| 445 | 445 | | the religious employer's bona fide religious tenets. The exclusion from coverage under this 31 |
|---|
| 446 | 446 | | subsection shall not apply to contraceptive services or procedures provided for purposes other than 32 |
|---|
| 447 | 447 | | contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of 33 |
|---|
| 448 | 448 | | menopause. 34 |
|---|
| 449 | 449 | | |
|---|
| 450 | 450 | | |
|---|
| 451 | 451 | | LC002275 - Page 13 of 15 |
|---|
| 452 | 452 | | (f) As used in this section, "religious employer" means an employer that is a "church or a 1 |
|---|
| 453 | 453 | | qualified church-controlled organization" as defined in 26 U.S.C. § 3121. 2 |
|---|
| 454 | 454 | | (g) Every religious employer that invokes the exemption provided under this section shall 3 |
|---|
| 455 | 455 | | provide written notice to prospective enrollees prior to enrollment with the plan, listing the 4 |
|---|
| 456 | 456 | | contraceptive healthcare services the employer refuses to cover for religious reasons. 5 |
|---|
| 457 | 457 | | (h) Beginning on the first day of each plan year after April 1, 2024, every health insurance 6 |
|---|
| 458 | 458 | | issuer offering group or individual health insurance coverage that covers prescription contraception 7 |
|---|
| 459 | 459 | | shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three 8 |
|---|
| 460 | 460 | | hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the 9 |
|---|
| 461 | 461 | | course of the twelve (12) month period at the discretion of the prescriber. 10 |
|---|
| 462 | 462 | | (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 11 |
|---|
| 463 | 463 | | devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 12 |
|---|
| 464 | 464 | | ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 13 |
|---|
| 465 | 465 | | preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 14 |
|---|
| 466 | 466 | | accordance with § 40-8-9. The department may base its determinations on findings from onsite 15 |
|---|
| 467 | 467 | | surveys, enrollee or other complaints, financial status, or any other source. 16 |
|---|
| 468 | 468 | | (j) The department shall monitor plan compliance in accordance with this section and shall 17 |
|---|
| 469 | 469 | | adopt and regulations rules for the implementation of this section, including the following: 18 |
|---|
| 470 | 470 | | (1) In addition to any requirements under state administrative procedures, the department 19 |
|---|
| 471 | 471 | | shall engage in a stakeholder process prior to the adoption of rules and regulations that include 20 |
|---|
| 472 | 472 | | healthcare service plans, pharmacy benefit plans, consumer representatives, including those 21 |
|---|
| 473 | 473 | | representing youth, low-income people, and communities of color, and other interested parties. The 22 |
|---|
| 474 | 474 | | department shall hold stakeholder meetings for stakeholders of different types to ensure sufficient 23 |
|---|
| 475 | 475 | | opportunity to consider factors and processes relevant to contraceptive coverage. The department 24 |
|---|
| 476 | 476 | | shall provide notice of stakeholder meetings on the department's website, and stakeholder meetings 25 |
|---|
| 477 | 477 | | shall be open to the public. 26 |
|---|
| 478 | 478 | | (2) The department shall conduct random reviews of each plan and its subcontractors to 27 |
|---|
| 479 | 479 | | ensure compliance with this section. 28 |
|---|
| 480 | 480 | | (3) The department shall submit an annual report to the general assembly and any other 29 |
|---|
| 481 | 481 | | appropriate entity with its findings from the random compliance reviews detailed in this section 30 |
|---|
| 482 | 482 | | and any other compliance or implementation efforts. This report shall be made available to the 31 |
|---|
| 483 | 483 | | public on the department’s website. 32 |
|---|
| 484 | 484 | | |
|---|
| 485 | 485 | | |
|---|
| 486 | 486 | | LC002275 - Page 14 of 15 |
|---|
| 487 | 487 | | SECTION 6. This act shall take effect upon passage. 1 |
|---|
| 488 | 488 | | ======== |
|---|
| 489 | 489 | | LC002275 |
|---|
| 490 | 490 | | ======== |
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| 491 | 491 | | |
|---|
| 492 | 492 | | |
|---|
| 493 | 493 | | LC002275 - Page 15 of 15 |
|---|
| 494 | 494 | | EXPLANATION |
|---|
| 495 | 495 | | BY THE LEGISLATIVE COUNCIL |
|---|
| 496 | 496 | | OF |
|---|
| 497 | 497 | | A N A C T |
|---|
| 498 | 498 | | RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES |
|---|
| 499 | 499 | | *** |
|---|
| 500 | 500 | | This act would require every individual or group health insurance contract effective on or 1 |
|---|
| 501 | 501 | | after January 1, 2026, to provide coverage to the insured and the insured's spouse and dependents 2 |
|---|
| 502 | 502 | | for all FDA-approved contraceptive drugs, devices and other products, voluntary sterilization 3 |
|---|
| 503 | 503 | | procedures, patient education and counseling on contraception and follow-up services as well as 4 |
|---|
| 504 | 504 | | Medicaid coverage for a twelve (12) month supply for Medicaid recipients. 5 |
|---|
| 505 | 505 | | This act would take effect upon passage. 6 |
|---|
| 506 | 506 | | ======== |
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| 507 | 507 | | LC002275 |
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| 508 | 508 | | ======== |
|---|