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,
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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.
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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
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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
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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
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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
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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."
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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.