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April 2002

Item: F012

  Contraceptive Equity Bills Gain Momentum in State Legislatures

In the United States almost 50% of pregnancies are unintended. Contraceptive equity legislation could reduce the number of unintended pregnancies and the need for abortion by providing affordable and reliable contraception for women.

Women Deserve Contraceptive Coverage

The issue of contraceptive equity gained momentum when insurance companies in large number decided to cover the male impotence drug Viagra. Women's groups argued that it was illogical to cover treatment of male sexual dysfunction without providing coverage for drugs and devices that would reduce the number of unwanted pregnancies. The Best of Contraceptive Equity Laws Meet Two Criteria:

1) The laws provide health care coverage for the full range of contraception needs by covering medical appointments and all FDA-approved drugs and devices;

2) The laws do not contain loopholes that weaken them and discriminate against women by permitting employers or health insurance plans to refuse coverage based on a religious view that their employees do not necessarily share.
The Congressional Budget Office determined in 1998 that contraceptive coverage for federal employees would NOT cost the federal government additional money.




Contraceptive Equity Addresses Women's Health Care Needs

  • Women of reproductive age spend 68% more than men on out-of-pocket health care costs, largely on reproductive health care services. Contraceptive equity laws can help bridge that spending gap.

  • Two-thirds of U.S women of childbearing age rely on private, employer-related plans for their health coverage, yet 49% of large group plans do not routinely cover any contraceptive method.

  • Only 15% of large group plans cover the five most common reversible forms of contraception-oral contraceptives, diaphragms, Depo Provera, IUDs and Norplant. Facts Refute Anti-Equity Misconceptions

There has been resistance to contraceptive equity legislation from some groups that oppose abortion and contraception. These groups incorrectly claim that the Pill and IUDs induce abortion instead of preventing pregnancy.

  • The fact is that the medical community defines pregnancy as the point at which the fertilized egg has attached itself to the uterine lining. The Pill and IUDs actually prevent pregnancy by stopping ovulation, fertilization of the egg, or implantation in the womb.

Health insurers have maintained that contraceptive equity legislation will drive up the cost of health care coverage.

  • According to one estimate, a sexually active woman who does not use contraception over the course of five years will experience 4.25 unintended pregnancies, costing upwards of $14,500 for a private insurer. This expense is significantly greater than the costs associated with any form of contraception.

State Proposals Parallel Federal EPICC Legislation

Increased attention to women's health care heightened interest in The Equity in Prescription Insurance and Contraceptive Coverage Act (EPICC), sponsored by U.S. Senators Olympia J. Snowe (R-ME) and Harry Reid (D-NV) and U.S. Representatives Jim Greenwood

(R-PA) and Nita M. Lowey (D-NY). EPICC is pending this year. Also, the FY99 Appropriations Bill (enacted in 1998) included a provision requiring the Federal Employees Health Benefit Program (FEHBP) to include comprehensive contraception coverage for federal employees. Since the provision is part of an Appropriations Bill, it must be re-approved by Congress on a yearly basis and currently awaits approval by the House of Representatives.



Contraceptive Equity Laws in the States

There are nineteen states with contraceptive equity laws in effect or that have been passed by state legislatures. See below for details on each state.

State: Arizona
Year Passed: 2002
Description of Law
Requires health insurance companies that offer prescription drugs and devices to their members to provide equal coverage of FDA-approved contraceptive drugs and devices. Policies that provide benefits for outpatient services shall also provide coverage for FDA approved prescription outpatient contraceptive services. Exempts religious employers that primarily employ and serve persons who share the religious tenets of the employer, if the employer also meets IRS non-profit requirements. Employers invoking the exemption must provide prospective enrollees written notice that they refuse to cover all FDA-approved contraceptive methods for religious reasons.
Effective Date: January 1, 2003

State: California
Year Passed: 1999
Description of Law

Requires individual and group health insurance policies that already cover prescriptions to provide FDA approved prescription contraception: exempt certain "religious employers" for whom "the inculcation of religious values is the purpose of the entity." The religious entity must also meet the requirements of non-profit status as defined in IRS code of 1986, as amended.
Effective Date: January 1, 2000

State: Connecticut
Year Passed: 1999
Description of Law

Requires individual and group health insurance policies that already cover prescriptions to provide FDA-approved prescription contraception; exempts certain "religious employers", as defined in IRS Code, from the requirement, as well as certain insurance companies and providers that are "owned, operated or substantially controlled by a religious organization which has religious or moral tenets which conflict" with contraceptive coverage.
Effective Date: October 1, 1999

State: Delaware
Year Passed: 2000
Description of Law
This Bill requires insurance coverage for all Food and Drug Administration(FDA) approved prescription contraceptive drugs and devices. A religious employer may request exemption from coverage under the policy, plan or contract if the required coverage conflicts with the religious organization's bona fide religious beliefs and practices. A religious employer that obtains an exemption shall provide its employees reasonable and timely notice of the exclusion.
Effective Date: June 7, 2000

State: Georgia
Year Passed: 1999
Description of Law

Requires every health benefit plan that already covers prescriptions to provide FDA-approved prescription contraception.
Effective Date: July 1, 1999

State: Hawaii
Year Passed: 1999
Description of Law

Requires employer group health policies, plans, etc. that cover pregnancy-related services to provide FDA-approved contraceptive drugs and devices; exempts all entities within a narrowly defined religious exemption but also requires employees of exempting employers to be eligible to purchase at low cost such contraceptive coverage.
Effective Date: January 1, 2000

State: Iowa
Year Passed: 2000
Description of Law

Requires every health benefit plan that already covers prescriptions to provide FDA-approved prescription contraception, as well as outpatient contraceptive services.
Effective Date: July 1, 2000

State: Maine
Year Passed: 1999
Description of Law

Requires insurance policies that provide coverage for prescription drugs or outpatient medical services to provide coverage for FDA-approved prescription contraceptives; exempts certain narrowly defined tax-exempt "religious employers", as defined in IRS Code.
Effective Date: March 1, 2000

State: Maryland
Year Passed: 1998
Description of Law

Requires insurance policies that provide coverage for prescription drugs to provide coverage for FDA-approved prescription contraceptive drugs and devices (including removal); exempts religious organizations if such coverage conflicts with their "bona fide religious beliefs and practices".
Effective Date: October 1, 1998

State: Massachusetts
Year Passed: 2002
Description of Law
Requires health benefit plans that already provide coverage for outpatient prescription drugs and devices to provide coverage for FDA approved prescription contraceptive drugs or devices and hormone replacement therapies. Policies that provide benefits for outpatient services shall also provide coverage for outpatient contraceptive services including consultations, examinations and medical procedures related to the use of all FDA approved contraceptive methods. Exempts policies purchased by an employer that is a church or qualified church-controlled organization as defined by US code.
Effective Date: January 1, 2003

State: Missouri
Year Passed: 2001
Description of Law

Requires health benefit plans that provide coverage for pharmaceutical benefits to provide coverage for all Food and Drug Administration (FDA) approved prescription drugs and devices; exempts any health carrier owned, operated, or controlled by an entity that is opposed to the use of contraceptives pursuant to their “moral, ethical or religious beliefs.” Health benefit plans that exclude coverage must provide written notice in informational materials.
Effective Date: January 1, 2002

State: New Hampshire
Year Passed: 1999
Description of Law

Requires every health benefit plan that already covers prescriptions to provide FDA-approved prescription contraception, as well as outpatient contraceptive services.
Effective Date: January 1, 2000

State: New Mexico
Year Passed: 2001
Description of Law

Requires insurance policies that provide coverage for prescription drugs to provide coverage for FDA-approved prescription contraceptive drugs or devices; allows “religious entities” who purchase health insurance coverage to elect to exclude prescription contraceptive drugs or devices.
Effective Date: June 19, 2001

State: Nevada
Year Passed: 1999
Description of Law

Requires insurance policies that provide coverage for prescription drugs to provide coverage for FDA-approved prescription contraceptive drugs and hormone replacement therapies; exempts insurers "affiliated with a religious organization" if it objects to coverage "on religious grounds".
Effective Date: October 1, 1999

State: North Carolina
Year Passed: 1999
Description of Law

Requires insurance policies that provide coverage for prescription drugs to provide coverage for FDA-approved prescription contraceptive drugs; provides religious exemption and excludes Preven, an emergency contraceptive, from provisions.
Effective Date: January 1, 2000

State: Rhode Island
Year Passed: 2000
Description of Law

Requires individual and group health insurance policies that already cover prescriptions to provide FDA approved prescription contraception: exempts certain "religious employers" as defined in the US Code, however every employer invoking the exemption must provide written notice to prospective enrollees, prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious purposes.
Effective Date: July 8, 2000

State: Texas
Year Passed: 2001
Description of Law
Requires health benefit plans that provide coverage for prescription drugs to provide coverage for all Food and Drug Administration (FDA) approved prescription contraceptive drugs and devices; exempts any health benefit plan issued by an entity associated with a religious organization, or any physician or health care provider under the health benefit plan, if such service “violates the religious convictions of the organization,” unless contraceptive coverage is necessary to preserve the life or health of the woman. Health benefit plans that limit or exclude coverage must provide written notice in informational materials.
Effective Date: September 1, 2001

State: Vermont
Year Passed: 1999
Description of Law

Requires insurance policies that provide coverage for prescription drugs to provide coverage for FDA-approved prescription contraceptive drugs, devices and sterilization.
Effective Date: July 1, 1999

State: Washington
Year Passed: 2001
Description of Law

Contraceptive rule, signed by the Insurance Commissioner, requires all regulated plans that offer prescription drug benefits to cover prescription contraceptive drugs and devices. The rule also requires coverage for "medical services associated with prescribing, dispensing, delivery, distribution, administration and removal" of contraceptives to the same extent as other outpatient services.
Effective Date: January 1, 2002































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