Equity in Prescription Insurance and Contraceptive Coverage Act of 2003 - Amends the Employee Retirement Income Security Act of 1974 and the Public Health Service Act to prohibit a group health plan, and a health insurance issuer providing group coverage, from: (1) excluding or restricting benefits for prescription contraceptive drugs, devices, and outpatient services if the plan provides benefits for other outpatient prescription drugs, devices, or outpatient services; (2) denying eligibility based on use or potential use of such items or services; (3) providing monetary payments or rebates to a covered individual to encourage acceptance of less than the minimum protections available; (4) penalizing, reducing, or limiting a professional's reimbursement because the professional prescribed such drugs or devices or provided such services; or (5) providing incentives to a professional to induce the professional to withhold drugs, devices, or services. Amends the Public Health Service Act to apply those prohibitions to coverage offered in the individual market.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1396 Introduced in Senate (IS)]
108th CONGRESS
1st Session
S. 1396
To require equitable coverage of prescription contraceptive drugs and
devices, and contraceptive services under health plans.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 11, 2003
Ms. Snowe (for herself, Mr. Reid, Ms. Mikulski, Mr. Leahy, Mr.
Lautenberg, Mr. Kennedy, Mrs. Murray, Mr. Smith, Mr. Corzine, Mr.
Biden, Mr. Sarbanes, Mr. Kerry, Mr. Warner, Mr. Inouye, Mrs. Lincoln,
Ms. Stabenow, Mr. Durbin, Mr. Chafee, Ms. Collins, and Mrs. Boxer)
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 2003''.
SEC. 2. FINDINGS.
Congress finds that--
(1) each year, 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:
for every $1 of public funds invested in family planning, $4 to
$14 of public funds is saved in pregnancy and health-related
costs;
(4) by reducing rates of unintended pregnancy,
contraceptives help reduce the need for abortion;
(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 exclude coverage for prescription
contraceptives;
(9) private insurance provides extremely limited coverage
of contraceptives: half of traditional indemnity plans and
preferred provider organizations, 20 percent of point-of-
service networks, and 7 percent of health maintenance
organizations cover no contraceptive methods other than
sterilization;
(10) 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;
(11) 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;
(12) 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'';
(13) in 1998, Congress agreed to provide contraceptive
coverage to the 2,000,000 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'';
(14) 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;
(15) eight in 10 privately insured adults support
contraceptive coverage; and
(16) 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
________________.
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 __________________.
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, 2005.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S9416)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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