ARIZONA STATE SENATE
Phoenix, Arizona
REVISED
FACT SHEET FOR H.B. 2234/S.B.
1100
health care coverage;
contraceptive coverage
Requires health insurance
companies that offer prescription drugs and devices to their members to also
provide equal coverage of Federal Drug Administration (FDA) approved
contraceptive drugs and devices as other drugs on the same level of the
formulary.
Since 1973, states have been
required to cover family planning services for Medicaid beneficiaries. However, a 2000 survey carried out by the
Arizona Family Planning Council found that 62 percent of Arizonans’ health care
plans did not cover contraceptives on an equal basis to other
prescriptions. On December 13, 2000,
the United States Equal Employment Opportunity Commission (EEOC) issued a
commission decision finding merit in two charges of discrimination in the
denial of health insurance coverage for prescription contraceptives. The EEOC found that this denial violated
Title VII of the Civil Rights Act of 1964, as amended by the Pregnancy
Discrimination Act, which prohibits sex discrimination by employers with 15 or
more employees. The EEOC based its
decision on the grounds that the respondents in the charges excluded the cost
of prescription contraceptive drugs – available only to women – from their
employee health plan while covering a number of other preventive drugs, devices
and services.
The FDA has approved five
contraceptive methods: Norplant implants, Depo-Provera, Intrauterine Device
(IUD), diaphragm and contraceptive pill.
In addition to birth control,
contraceptives are medically necessary for a variety of problems that women may
incur including regulating a woman's cycle and endometrial and ovarian
cancer. According to the National
Council of State Legislatures, 19 states have passed legislation requiring
insurers who cover prescription drugs to offer coverage for prescription
contraceptives.
This legislation applies to
subscription insurance contracts, health care service organizations, group
disability policies, blanket disability policies and accountable health
plans. Under this legislation, plans
already covering prescription drugs and devices would include equal cost
containment measures for prescription contraceptive drugs and devices as other
drugs on the same level of the formulary. Also, plans that include coverage for
outpatient medical services would include FDA approved outpatient contraceptive
services in that coverage.
The health insurance
purchased by the State on behalf of its employees covers some forms of
prescription contraceptives depending on the employee’s plan coverage. The fiscal impact to the state general fund
for this legislation is not currently discernable.
Provisions
1. Requires subscription insurance contracts, health care service organizations, group disability policies, blanket disability policies and accountable health plans that provide coverage for:
a.
prescription
drugs to also provide coverage for FDA approved contraceptives.
b.
outpatient
health care services to also provide coverage for FDA approved prescription
outpatient contraceptive services.
2. Prohibits subscription insurance contracts, health care service organizations, group disability policies, blanket disability policies and accountable health plans from imposing cost containment measures for contraceptive drugs that are greater than the cost containment measures for other drugs on the same level of the formulary.
3. Allows religious employers to obtain health insurance coverage without contraceptive coverage.
4. Requires the religious employer submit a written affidavit to the insurer stating it is a religious employer.
5. Requires the insurer to issue to the religious employer a contract without contraceptive coverage upon receipt of the affidavit.
6. Requires the insurer retain the affidavit for the duration of the contract and any renewals of the contract.
7. Requires any religious employer invoking the exemption to notify employees that contraceptives will not be covered.
8. Excludes prescription contraceptive methods ordered by a health care provider for medical conditions other than preventing pregnancy.
9. Allows an insurer to require the employee pay for the prescription then submit a claim to the insurer for reimbursement along with evidence the prescription is for a noncontraceptive (i.e. covered) purpose.
10. Allows the insurer to charge an administrative fee for handling prescriptions for noncontraceptive purpose claims.
11. Prohibits religious employers from discriminating against an employee who chooses to obtain contraceptive coverage from another source.
12. Defines "religious employer".
13. Applies to policies issued or renewed on January 1, 2003.
14. Provides for a general effective date.
Amendments
Adopted by Committee (S.B. 1100)
1. Eliminates experimental or investigational contraceptive coverage.
2. Clarifies the definition of outpatient contraceptive services.
3. Specifies the drug formulary as multitiered.
4. Requires health care insurance companies that provide coverage for prescription drugs to provide equal cost containment measures for contraceptive drugs as other drugs on the same level of the formulary.
Amendments
Adopted by Committee of the Whole (S.B. 1100)
1. Eliminates experimental or investigational coverage from required coverage.
2. Clarifies language relating to the drug formulary.
3. Clarifies the definition of outpatient contraceptive services.
4. Requires health care insurance companies that provide coverage for prescription drugs to provide equal cost containment measures for contraceptive drugs as other drugs on the same level of the formulary.
5. Eliminates individual insurance policies from the legislation.
6. Creates an exemption for religious employers to allow them to obtain health insurance contracts without contraceptive coverage.
7. Requires any employer invoking the exemption to notify employees that contraception will not be covered before they enroll in the health plan.
8. Specifies that a religious employer may not discriminate against an employee who independently seeks contraceptives.
9. Defines term.
10. Applies to policies issued or renewed on January 1, 2003.
Senate Action
House Action
BI 2/7/02 DPA 4-2-0 HEA 3/18/02 DPA 7-0-0-3
3rd Read 4/15/02 17-10-3 3rd Read 4/2/02 38-17-5
(S.B. 1100 was substituted for H.B. 2234 on 3rd read)
Prepared by Senate Staff
April 16, 2002