PRINTER'S NO. 357
No. 316 Session of 2007
INTRODUCED BY LEACH, RUBLEY, BENNINGTON, BISHOP, CURRY, DePASQUALE, FREEMAN, GERGELY, JOSEPHS, MAHONEY, MANDERINO, MANN, MUNDY, M. O'BRIEN, PAYTON, ROEBUCK, ROSS, STURLA, R. TAYLOR, WALKO AND YOUNGBLOOD, FEBRUARY 7, 2007
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, FEBRUARY 7, 2007
AN ACT 1 To ensure equitable coverage of prescription contraceptive drugs 2 and devices and the medical and counseling services necessary 3 for their effective use. 4 The General Assembly of the Commonwealth of Pennsylvania 5 hereby enacts as follows: 6 Section 1. Short title. 7 This act shall be known and may be cited as the Prescription 8 Contraception Equity Act. 9 Section 2. Findings. 10 The General Assembly finds and declares as follows: 11 (1) Each year, more than 3,000,000 women face an 12 unintended pregnancy, representing nearly half of all 13 pregnancies in the United States. 14 (2) By reducing rates of unintended pregnancy, 15 contraception improves women's health and well-being, reduces 16 infant morbidity and mortality and reduces the need for 17 abortion.
1 (3) The cost of adding insurance coverage for all FDA- 2 approved contraception and related medical and counseling 3 services has been estimated at less than $2 per employee per 4 month. 5 (4) Most insurance policies cover prescription drugs and 6 devices and outpatient medical and counseling services but do 7 not cover all methods of FDA-approved contraception and the 8 medical and counseling services necessary for their effective 9 use. Many policies cover no reversible methods of 10 contraception at all. 11 (5) Health insurance policies that fail to cover 12 prescription contraception and related medical and counseling 13 services discriminate against women and place effective forms 14 of contraception beyond the financial reach of many families. 15 Women of reproductive age spend 68% more than men on out-of- 16 pocket health care costs. Contraceptive drugs, devices and 17 related medical and counseling services account for much of 18 this difference. 19 (6) At least 23 states have enacted laws to address the 20 inequity in prescription coverage caused by exclusion of 21 contraceptives. Women in this Commonwealth also deserve this 22 protection. 23 (7) The Equal Employment Opportunity Commission ruled in 24 2000 that employers may not discriminate against women in 25 their health insurance plans by denying benefits for 26 prescription contraceptives if they provide benefits for 27 drugs, devices and services used to prevent other medical 28 conditions. On June 12, 2001, a Federal district court ruled 29 in Erickson v. Bartell Drug Company that an employer's 30 exclusion of prescription contraception from a health plan 20070H0316B0357 - 2 -
1 that covers other prescription drugs and devices is illegal 2 sex discrimination in violation of Title VII of the Civil 3 Rights Act of 1964 (Public Law 88-352, 78 Stat. 241), as 4 amended by the act of October 31, 1978 (Public Law 95-555, 92 5 Stat. 2076), referred to as the Pregnancy Discrimination Act. 6 (8) Following the inclusion of contraceptive coverage in 7 the Federal Employees Health Benefits Program in 1999, the 8 United States Office of Personnel Management reported that no 9 increased cost had been incurred as a result of the added 10 coverage. 11 (9) This act affects the business of insurance. The 12 requirements of this act govern entities within the insurance 13 industry that provide health insurance policies as defined by 14 this act. The provisions of this act transfer and spread an 15 insured's risk and are an integral part of the policy 16 relationship between the insurer and the insured. 17 Section 3. Definitions. 18 The following words and phrases when used in this act shall 19 have the meanings given to them in this section unless the 20 context clearly indicates otherwise: 21 "Health insurance policy." 22 (1) Any individual or group health insurance policy, 23 contract or plan with coverage for prescription drugs that 24 provides medical coverage on an expense-incurred service or 25 prepaid basis issued by an entity subject to any one of the 26 following: 27 (i) The act of May 17, 1921 (P.L.682, No.284), known 28 as The Insurance Company Law of 1921. 29 (ii) Subarticle (f) of Article IV of the act of June 30 13, 1967 (P.L.31, No.21), known as the Public Welfare 20070H0316B0357 - 3 -
1 Code. 2 (iii) The act of December 29, 1972 (P.L.1701, 3 No.364), known as the Health Maintenance Organization 4 Act. 5 (iv) The act of May 18, 1976 (P.L.123, No.54), known 6 as the Individual Accident and Sickness Insurance Minimum 7 Standards Act. 8 (v) 40 Pa.C.S. Ch. 61 (relating to hospital plan 9 corporations) or 63 (relating to professional health 10 services plan corporations). 11 (2) The term does not include any of the following types 12 of insurance or a combination of any of the following types 13 of insurance: 14 (i) Short-term travel. 15 (ii) Accident-only. 16 (iii) Workers' compensation. 17 (iv) Short-term nonrenewable policies of not more 18 than six months' duration. 19 (v) Hospital indemnity. 20 (vi) Specified disease. 21 (vii) Disability income. 22 (viii) Dental. 23 (ix) Vision. 24 (x) Civilian Health and Medical Program of the 25 Uniformed Services (CHAMPUS) supplement. 26 (xi) Medicare or Medicaid supplemental contract. 27 (xii) Long-term care. 28 (xiii) Limited coverage accident and sickness 29 policy. This subparagraph includes cancer insurance, 30 polio insurance and any similar policy identified as 20070H0316B0357 - 4 -
1 exempt from this section by the Insurance Commissioner. 2 "Limitation." Any copayment, deductible or other cost- 3 sharing mechanism or premium differential. 4 "Outpatient medical or counseling service necessary for the 5 effective use of contraception." The term includes, but is not 6 limited to, examinations, procedures and medical and counseling 7 services provided on an outpatient basis and services for 8 initial and periodic comprehensive physical examinations, 9 medical, laboratory and radiology services warranted by the 10 initial and periodic examinations or by the history, physical 11 findings or risk factors, including medical services necessary 12 for the insertion and removal of any contraceptive drug or 13 device and individual or group family planning counseling. 14 "Prescription contraceptive device." Any regimen of a 15 prescription contraceptive device approved by the Food and Drug 16 Administration, as well as any generic equivalent approved as 17 substitutable by the Food and Drug Administration. 18 "Prescription contraceptive drug." Any regimen of a 19 prescription contraceptive drug approved by the Food and Drug 20 Administration, as well as any generic equivalent approved as 21 substitutable by the Food and Drug Administration. 22 Section 4. Mandated coverage. 23 (a) General rule.--A health insurance policy that is 24 delivered, issued for delivery, renewed, extended or modified in 25 this Commonwealth on or after the effective date of this act 26 shall provide that the health insurance benefits applicable 27 under the policy include coverage for: 28 (1) Any prescription contraceptive drug, if the policy 29 provides coverage for other prescription drugs. 30 (2) Any prescription contraceptive device, if the policy 20070H0316B0357 - 5 -
1 provides coverage for other prescription devices. 2 (3) Any outpatient medical or counseling service 3 necessary for the effective use of contraception, if the 4 policy provides coverage for other outpatient medical or 5 counseling services. 6 (b) Exceptions.--Nothing in this act shall be construed to 7 prevent a health insurance policy from imposing a limitation in 8 relation to any of the following, provided that the limitation 9 for this coverage is not greater than or different from all 10 other limitations imposed under general terms and conditions 11 under the policy: 12 (1) Coverage for prescription contraceptive drugs. 13 (2) Coverage for prescription contraceptive devices. 14 (3) Coverage for outpatient medical or counseling 15 services necessary for the effective use of contraception. 16 Section 5. Effective date. 17 This act shall take effect in 180 days. A26L40BIL/20070H0316B0357 - 6 -