REPORT TITLE: Contraceptive Services DESCRIPTION: Requires all health insurers, mutual benefit societies, and health maintenance organizations to cease excluding contraceptive services and supplies from coverage by repealing the provision of such coverage as an employer option; exempts certain employers from providing coverage for contraceptive health care services and supplies that are contrary to the employer's religious tenets. (CD1) 822 THE SENATE S.B. NO. S.D. 2 TWENTIETH LEGISLATURE, 1999 H.D. 2 STATE OF HAWAII C.D. 1 ________________________________________________________________ ________________________________________________________________ A BILL FOR AN ACT RELATING TO HEALTH INSURANCE. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII: 1 SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended 2 by adding a new section to article 10A to be appropriately 3 designated and to read as follows: 4 "�1:10A- Contraceptive services; religious employers 5 exemption. (a) A "religious employer" is an entity for which 6 each of the following is true: 7 (1) The inculcation of religious values is the purpose of 8 the entity; 9 (2) The entity primarily employs persons who share the 10 religious tenets of the entity; 11 (3) The entity is not staffed by public employees; and 12 (4) The entity is a nonprofit organization as defined under 13 section 501(c)(3) of the Internal Revenue Code of 1986, 14 as amended. 15 For the purpose of this definition, any educational, health care, 16 or other non-profit institution or organization owned or 17 controlled by the religious employer is included in this 18 exemption. 19 (b) Notwithstanding any other provision of this chapter, Page 2 822 S.B. NO. S.D. 2 H.D. 2 C.D. 1 1 any religious employer may request a health insurance plan 2 without coverage for contraceptive services and supplies that are 3 contrary to the religious employer's religious tenets. If so 4 requested, the health insurer, mutual benefit society, or health 5 maintenance organization shall provide a health insurance plan 6 without coverage for contraceptive services and supplies. This 7 subsection shall not be construed to deny an enrollee coverage 8 of, and timely access to contraceptive services and supplies. 9 (c) Each religious employer that invokes the exemption 10 provided under this section shall: 11 (1) Provide written notice to enrollees upon enrollment 12 with the plan, listing the contraceptive health care 13 services the employer refuses to cover for religious 14 reasons; 15 (2) Provide written information describing how an enrollee 16 may directly access contraceptive services and supplies 17 in an expeditious manner; and 18 (3) Ensure that enrollees who are refused contraceptive 19 services and supplies coverage under this section have 20 prompt access to the information developed under 21 paragraph (2). Such notice shall appear, in not less 22 than twelve point type, in the policy, application, and 23 sales brochure for such policy. Page 3 822 S.B. NO. S.D. 2 H.D. 2 C.D. 1 1 (d) Nothing in this section shall be construed to exclude 2 coverage for prescription contraceptive supplies ordered by a 3 health care provider with prescriptive authority for reasons 4 other than contraceptive purposes, such as decreasing the risk of 5 ovarian cancer or eliminating symptoms of menopause, or for 6 prescription contraception that is necessary to preserve the life 7 or health of an enrollee. 8 (e) Health insurers, mutual benefit societies, and health 9 maintenance organizations shall allow enrollees in a health plan 10 exempted under this section to directly purchase coverage of 11 contraceptive supplies and outpatient contraceptive services. 12 The enrollee's cost of purchasing such coverage shall not exceed 13 the enrollee's pro rata share of the price the group purchaser 14 would have paid for such coverage had the group plan not invoked 15 a religious exemption. 16 (f) This section shall not be construed as to require a 17 health insurer, mutual benefit society, health maintenance 18 organization, health care facility, or health care provider to 19 provide any health care services without appropriate payment of 20 premium or fee. 21 (g) For purposes of this section: 22 "Contraceptive services" means physician-delivered, 23 physician-supervised, physician assistant-delivered, nurse Page 4 822 S.B. NO. S.D. 2 H.D. 2 C.D. 1 1 practitioner-delivered, certified nurse midwife-delivered, or 2 nurse-delivered medical services intended to promote the 3 effective use of contraceptive supplies or devices to prevent 4 unwanted pregnancy. 5 "Contraceptive supplies" means all Food and Drug 6 Administration-approved contraceptive drugs or devices used to 7 prevent unwanted pregnancy." 8 SECTION 2. Section 431:10A-116.6, Hawaii Revised Statutes, 9 is amended to read as follows: 10 "[[]�1:10A-116.6[]] Contraceptive services[; options]. 11 (a) Notwithstanding any provision of law to the contrary, each 12 employer group health policy, contract, plan, or agreement issued 13 or renewed in this State on or after January 1, [1994, that 14 provides for payment of or reimbursement for pregnancy-related 15 services, shall provide as an employer option,] 2000, shall cease 16 to exclude contraceptive services or supplies for the subscriber 17 or any dependent of the subscriber who is covered by the 18 policy[.], subject to the exclusion under section 431:10A- . 19 (b) [Any] Except as provided in subsection (c), all 20 policies, contracts, plans, or agreements under subsection (a) 21 [above], that provide contraceptive services or supplies, or 22 prescription drug coverage, shall not exclude any [Food and Drug 23 Administration-approved prescriptive contraceptive drug or Page 5 822 S.B. NO. S.D. 2 H.D. 2 C.D. 1 1 device,] prescription contraceptive supplies or impose any 2 unusual copayment, charge, or waiting requirement for such [drug 3 or device.] supplies. 4 (c) Coverage for oral contraceptives shall include at least 5 one brand from the monophasic, multiphasic, and the progestin- 6 only categories. A member shall receive coverage for any other 7 oral contraceptive only if: 8 (1) Use of brands covered has resulted in an adverse drug 9 reaction; or 10 (2) The member has not used the brands covered and, based 11 on the member's past medical history, the prescribing 12 health care provider believes that use of the brands 13 covered would result in an adverse reaction. 14 [(c)] (d) For [the purpose] purposes of this section[, 15 "contraceptive services"]: 16 "Contraceptive services" means physician-delivered, 17 physician-supervised, physician assistant-delivered, nurse 18 practitioner-delivered, certified nurse midwife-delivered, or 19 nurse-delivered medical services intended to promote the 20 effective use of [prescription] contraceptive supplies or devices 21 to prevent unwanted pregnancy. 22 "Contraceptive supplies" means all Food and Drug 23 Administration-approved contraceptive drugs or devices used to Page 6 822 S.B. NO. S.D. 2 H.D. 2 C.D. 1 1 prevent unwanted pregnancy. 2 [(d)] (e) Nothing in this section shall be construed to 3 extend the practice or privileges of any health care provider 4 beyond that provided in the laws governing the provider's 5 practice and privileges." 6 SECTION 3. Section 432:1-604.5, Hawaii Revised Statutes, is 7 amended to read as follows: 8 "[[]�2:1-604.5[]] Contraceptive services [; options]. 9 (a) Notwithstanding any provision of law to the contrary, each 10 employer group health policy, contract, plan, or agreement issued 11 or renewed in this State on or after January 1, [1994, that 12 provides for payment of or reimbursement for pregnancy-related 13 services, shall provide as an employer option,] 2000, shall cease 14 to exclude contraceptive services or supplies, and contraceptive 15 prescription drug coverage for the subscriber or any dependent of 16 the subscriber who is covered by the policy[.], subject to the 17 exclusion under section 431:10A- . 18 (b) [Any] Except as provided in subsection (c), all 19 policies, contracts, plans, or agreements under subsection (a), 20 that provide contraceptive services or supplies, or prescription 21 drug coverage, shall not exclude any [Federal Drug 22 Administration-approved prescriptive contraceptive drug or 23 device,] prescription contraceptive supplies or impose any Page 7 822 S.B. NO. S.D. 2 H.D. 2 C.D. 1 1 unusual copayment, charge, or waiting requirement for such drug 2 or device. 3 (c) Coverage for contraceptives shall include at least one 4 brand from the monophasic, multiphasic, and the progestin-only 5 categories. A member shall receive coverage for any other oral 6 contraceptive only if: 7 (1) Use of brands covered has resulted in an adverse drug 8 reaction; or 9 (2) The member has not used the brands covered and, based 10 on the member's past medical history, the prescribing 11 health care provider believes that use of the brands 12 covered would result in an adverse reaction. 13 [(c)] (d) For [the purpose] purposes of this section[, 14 "contraceptive services"]: 15 "Contraceptive services" means physician-delivered, 16 physician-supervised, physician assistant-delivered, nurse 17 practitioner-delivered, certified nurse midwife-delivered, or 18 nurse-delivered medical services intended to promote the 19 effective use of [prescription] contraceptive supplies or devices 20 to prevent unwanted pregnancy. 21 "Contraceptive supplies" means all Food and Drug 22 Administration-approved contraceptive drugs or devices used to 23 prevent unwanted pregnancy." Page 8 822 S.B. NO. S.D. 2 H.D. 2 C.D. 1 1 [(d)] (e) Nothing in this section shall be construed to 2 extend the practice or privileges of any health care provider 3 beyond that provided in the laws governing the provider's 4 practice and privileges." 5 SECTION 4. The insurance commissioner shall review the 6 experience of employers in providing coverage of contraceptive 7 services and supplies as part of their health insurance coverage 8 for employees after the effective date of this Act to determine 9 whether the cost of health insurance has increased as a result of 10 this Act. The review shall include an assessment of the impact 11 of contraceptive coverage on reducing maternity costs, employee 12 turnover, and absenteeism costs around maternity and 13 family-related costs. The insurance providers and business 14 organizations, including the Chamber of Commerce of Hawaii, are 15 requested to assist the insurance commissioner in obtaining the 16 necessary information from employers to effectuate the review. 17 The insurance commissioner shall submit a report of the 18 insurance commissioner's findings to the legislature no later 19 than twenty days prior to the convening of the regular session of 20 2001. 21 SECTION 5. Statutory material to be repealed is bracketed. 22 New statutory material is underscored. 23 SECTION 6. This Act shall take effect upon its approval.