S 3068
110th CONGRESS
2d Session
S. 3068
To require equitable coverage of prescription contraceptive
drugs and devices, and contraceptive services under health plans.
IN THE SENATE OF THE UNITED STATES
May 22, 2008
Ms. SNOWE (for herself, Mr. REID, Ms. COLLINS, Mr. DURBIN, Mr. WARNER,
Mr. KERRY, Mrs. BOXER, Mr. DODD, Mr. LAUTENBERG, Mrs. LINCOLN, and Mr.
MENENDEZ) introduced the following bill; which was read twice and referred
to the Committee on Health, Education, Labor, and Pensions
A BILL
To require equitable coverage of prescription contraceptive
drugs and devices, and contraceptive services under health plans.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Equity in Prescription Insurance and Contraceptive
Coverage Act of 2007'.
SEC. 2. FINDINGS.
(1) each year, over 3,000,000 pregnancies, or one-half of all pregnancies,
in the United States are unintended;
(2) contraceptives and contraceptive services are part of basic health
care, allowing families to both adequately space desired pregnancies
and avoid unintended pregnancy, and should be provided on the same
terms and conditions as other basic health care;
(3) studies show that contraceptives are cost effective: it is estimated
that for every $1 of public funds invested in family planning, $3
is saved in Medicaid costs from pregnancy-related health care and
medical care for newborns;
(4) by reducing rates of unintended pregnancy, contraceptives help
reduce abortions;
(5) unintended pregnancies lead to higher rates of infant mortality,
low-birth weight, and maternal morbidity, and threaten the economic
viability of families;
(6) the National Commission to Prevent Infant Mortality determined
that `infant mortality could be reduced by 10 percent if all women
not desiring pregnancy used contraception';
(7) most women in the United States, including three-quarters of women
of childbearing age, rely on some form of private insurance (through
their own employer, a family member's employer, or the individual
market) to defray their medical expenses;
(8) the vast majority of private insurers cover prescription drugs,
but many continue to exclude coverage for prescription contraceptives;
(9) women of reproductive age spend 68 percent more than men on out-of-pocket
health care costs, with contraceptives and reproductive health care
services accounting for much of the difference;
(10) the lack of contraceptive coverage in health insurance places
many effective forms of contraceptives beyond the financial reach
of many women, leading to unintended pregnancies;
(11) the Institute of Medicine Committee on Unintended Pregnancy recommended
that `financial barriers to contraception be reduced by increasing
the proportion of all health insurance policies that cover contraceptive
services and supplies';
(12) in 1998, Congress agreed to provide contraceptive coverage to
women of reproductive age who are participating in the Federal Employees
Health Benefits Program, the largest employer-sponsored health insurance
plan in the world, and in 2001, the Office of Personnel Management
reported that it did not raise premiums as a result of such coverage
because there was `no cost increase due to contraceptive coverage';
(13) contraceptive coverage saves employers money: the Washington
Business Group on Health estimates that not covering contraceptives
in employee health plans costs employers 15 to 17 percent more than
providing such coverage;
(14) eight in 10 privately insured adults support contraceptive coverage;
and
(15) Healthy People 2010, published by the Office of the Surgeon General,
has established a 10-year national public health goal to increase
the percentage of health plans that cover contraceptives.
SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT
OF 1974.
(a) In General- Subpart B of part 7 of subtitle B of title I of the
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.)
is amended by adding at the end the following:
`SEC. 714. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.
`(a) Requirements for Coverage- A group health plan, and a health insurance
issuer providing health insurance coverage in connection with a group
health plan, may not--
`(1) exclude or restrict benefits for prescription contraceptive drugs
or devices approved by the Food and Drug Administration, or generic
equivalents approved as substitutable by the Food and Drug Administration,
if such plan or coverage provides benefits for other outpatient prescription
drugs or devices; or
`(2) exclude or restrict benefits for outpatient contraceptive services
if such plan or coverage provides benefits for other outpatient services
provided by a health care professional (referred to in this section
as `outpatient health care services').
`(b) Prohibitions- A group health plan, and a health insurance issuer
providing health insurance coverage in connection with a group health
plan, may not--
`(1) deny to an individual eligibility, or continued eligibility,
to enroll or to renew coverage under the terms of the plan because
of the individual's or enrollee's use or potential use of items or
services that are covered in accordance with the requirements of this
section;
`(2) provide monetary payments or rebates to a covered individual
to encourage such individual to accept less than the minimum protections
available under this section;
`(3) penalize or otherwise reduce or limit the reimbursement of a
health care professional because such professional prescribed contraceptive
drugs or devices, or provided contraceptive services, described in
subsection (a), in accordance with this section; or
`(4) provide incentives (monetary or otherwise) to a health care professional
to induce such professional to withhold from a covered individual
contraceptive drugs or devices, or contraceptive services, described
in subsection (a).
`(c) Rules of Construction-
`(1) IN GENERAL- Nothing in this section shall be construed--
`(A) as preventing a group health plan and a health insurance issuer
providing health insurance coverage in connection with a group health
plan from imposing deductibles, coinsurance, or other cost-sharing
or limitations in relation to--
`(i) benefits for contraceptive drugs under the plan or coverage,
except that such a deductible, coinsurance, or other cost-sharing
or limitation for any such drug shall be consistent with those
imposed for other outpatient prescription drugs otherwise covered
under the plan or coverage;
`(ii) benefits for contraceptive devices under the plan or coverage,
except that such a deductible, coinsurance, or other cost-sharing
or limitation for any such device shall be consistent with those
imposed for other outpatient prescription devices otherwise covered
under the plan or coverage; and
`(iii) benefits for outpatient contraceptive services under the
plan or coverage, except that such a deductible, coinsurance,
or other cost-sharing or limitation for any such service shall
be consistent with those imposed for other outpatient health care
services otherwise covered under the plan or coverage;
`(B) as requiring a group health plan and a health insurance issuer
providing health insurance coverage in connection with a group health
plan to cover experimental or investigational contraceptive drugs
or devices, or experimental or investigational contraceptive services,
described in subsection (a), except to the extent that the plan
or issuer provides coverage for other experimental or investigational
outpatient prescription drugs or devices, or experimental or investigational
outpatient health care services; or
`(C) as modifying, diminishing, or limiting the rights or protections
of an individual under any other Federal law.
`(2) LIMITATIONS- As used in paragraph (1), the term `limitation'
includes--
`(A) in the case of a contraceptive drug or device, restricting
the type of health care professionals that may prescribe such drugs
or devices, utilization review provisions, and limits on the volume
of prescription drugs or devices that may be obtained on the basis
of a single consultation with a professional; or
`(B) in the case of an outpatient contraceptive service, restricting
the type of health care professionals that may provide such services,
utilization review provisions, requirements relating to second opinions
prior to the coverage of such services, and requirements relating
to preauthorizations prior to the coverage of such services.
`(d) Notice Under Group Health Plan- The imposition of the requirements
of this section shall be treated as a material modification in the terms
of the plan described in section 102(a)(1), for purposes of assuring
notice of such requirements under the plan, except that the summary
description required to be provided under the last sentence of section
104(b)(1) with respect to such modification shall be provided by not
later than 60 days after the first day of the first plan year in which
such requirements apply.
`(e) Preemption- Nothing in this section shall be construed to preempt
any provision of State law to the extent that such State law establishes,
implements, or continues in effect any standard or requirement that
provides coverage or protections for participants or beneficiaries that
are greater than the coverage or protections provided under this section.
`(f) Definition- In this section, the term `outpatient contraceptive
services' means consultations, examinations, procedures, and medical
services, provided on an outpatient basis and related to the use of
contraceptive methods (including natural family planning) to prevent
an unintended pregnancy.'.
(b) Clerical Amendment- The table of contents in section 1 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1001) is amended by
inserting after the item relating to section 713 the following:
`Sec. 714. Standards relating to benefits for contraceptives.'.
(c) Effective Date- The amendments made by this section shall apply
with respect to plan years beginning on or after January 1, 2008.
SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE
GROUP MARKET.
(a) In General- Subpart 2 of part A of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at the
end the following:
`SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.
`(a) Requirements for Coverage- A group health plan, and a health insurance
issuer providing health insurance coverage in connection with a group
health plan, may not--
`(1) exclude or restrict benefits for prescription contraceptive drugs
or devices approved by the Food and Drug Administration, or generic
equivalents approved as substitutable by the Food and Drug Administration,
if such plan or coverage provides benefits for other outpatient prescription
drugs or devices; or
`(2) exclude or restrict benefits for outpatient contraceptive services
if such plan or coverage provides benefits for other outpatient services
provided by a health care professional (referred to in this section
as `outpatient health care services').
`(b) Prohibitions- A group health plan, and a health insurance issuer
providing health insurance coverage in connection with a group health
plan, may not--
`(1) deny to an individual eligibility, or continued eligibility,
to enroll or to renew coverage under the terms of the plan because
of the individual's or enrollee's use or potential use of items or
services that are covered in accordance with the requirements of this
section;
`(2) provide monetary payments or rebates to a covered individual
to encourage such individual to accept less than the minimum protections
available under this section;
`(3) penalize or otherwise reduce or limit the reimbursement of a
health care professional because such professional prescribed contraceptive
drugs or devices, or provided contraceptive services, described in
subsection (a), in accordance with this section; or
`(4) provide incentives (monetary or otherwise) to a health care professional
to induce such professional to withhold from covered individual contraceptive
drugs or devices, or contraceptive services, described in subsection
(a).
`(c) Rules of Construction-
`(1) IN GENERAL- Nothing in this section shall be construed--
`(A) as preventing a group health plan and a health insurance issuer
providing health insurance coverage in connection with a group health
plan from imposing deductibles, coinsurance, or other cost-sharing
or limitations in relation to--
`(i) benefits for contraceptive drugs under the plan or coverage,
except that such a deductible, coinsurance, or other cost-sharing
or limitation for any such drug shall be consistent with those
imposed for other outpatient prescription drugs otherwise covered
under the plan or coverage;
`(ii) benefits for contraceptive devices under the plan or coverage,
except that such a deductible, coinsurance, or other cost-sharing
or limitation for any such device shall be consistent with those
imposed for other outpatient prescription devices otherwise covered
under the plan or coverage; and
`(iii) benefits for outpatient contraceptive services under the
plan or coverage, except that such a deductible, coinsurance,
or other cost-sharing or limitation for any such service shall
be consistent with those imposed for other outpatient health care
services otherwise covered under the plan or coverage;
`(B) as requiring a group health plan and a health insurance issuer
providing health insurance coverage in connection with a group health
plan to cover experimental or investigational contraceptive drugs
or devices, or experimental or investigational contraceptive services,
described in subsection (a), except to the extent that the plan
or issuer provides coverage for other experimental or investigational
outpatient prescription drugs or devices, or experimental or investigational
outpatient health care services; or
`(C) as modifying, diminishing, or limiting the rights or protections
of an individual under any other Federal law.
`(2) LIMITATIONS- As used in paragraph (1), the term `limitation'
includes--
`(A) in the case of a contraceptive drug or device, restricting
the type of health care professionals that may prescribe such drugs
or devices, utilization review provisions, and limits on the volume
of prescription drugs or devices that may be obtained on the basis
of a single consultation with a professional; or
`(B) in the case of an outpatient contraceptive service, restricting
the type of health care professionals that may provide such services,
utilization review provisions, requirements relating to second opinions
prior to the coverage of such services, and requirements relating
to preauthorizations prior to the coverage of such services.
`(d) Notice- A group health plan under this part shall comply with the
notice requirement under section 714(d) of the Employee Retirement Income
Security Act of 1974 with respect to the requirements of this section
as if such section applied to such plan.
`(e) Preemption- Nothing in this section shall be construed to preempt
any provision of State law to the extent that such State law establishes,
implements, or continues in effect any standard or requirement that
provides coverage or protections for enrollees that are greater than
the coverage or protections provided under this section.
`(f) Definition- In this section, the term `outpatient contraceptive
services' means consultations, examinations, procedures, and medical
services, provided on an outpatient basis and related to the use of
contraceptive methods (including natural family planning) to prevent
an unintended pregnancy.'.
(b) Effective Date- The amendments made by this section shall apply
with respect to group health plans for plan years beginning on or after
January 1, 2008.
SEC. 5. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE
INDIVIDUAL MARKET.
(a) In General- Part B of title XXVII of the Public Health Service Act
(42 U.S.C. 300gg-41 et seq.) is amended--
(1) by redesignating the first subpart 3 (relating to other requirements)
as subpart 2; and
(2) by adding at the end of subpart 2 the following:
`SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.
`The provisions of section 2707 shall apply to health insurance coverage
offered by a health insurance issuer in the individual market in the
same manner as they apply to health insurance coverage offered by a
health insurance issuer in connection with a group health plan in the
small or large group market.'.
(b) Effective Date- The amendment made by this section shall apply with
respect to health insurance coverage offered, sold, issued, renewed,
in effect, or operated in the individual market on or after January
1, 2008.
END
