THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY LEACH, KITCHEN, BOSCOLA, WILLIAMS, TARTAGLIONE AND FERLO, FEBRUARY 7, 2011

REFERRED TO BANKING AND INSURANCE, FEBRUARY 7, 2011  

AN ACT

To ensure equitable coverage of prescription contraceptive drugs

and devices and the medical and counseling services necessary

for their effective use.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Short title.

This act shall be known and may be cited as the Prescription

Contraception Equity Act.

Section 2.  Findings.

The General Assembly finds and declares as follows:

(1)  Each year, more than 3,000,000 women face an

unintended pregnancy, representing nearly half of all

pregnancies in the United States.

(2)  By reducing rates of unintended pregnancy,

contraception improves women's health and well-being, reduces

infant morbidity and mortality and reduces the need for

abortion.

(3)  The cost of adding insurance coverage for all FDA-

approved contraception and related medical and counseling

services has been estimated at less than $2 per employee per

month.

(4)  Most insurance policies cover prescription drugs and

devices and outpatient medical and counseling services but do

not cover all methods of FDA-approved contraception and the

medical and counseling services necessary for their effective

use. Many policies cover no reversible methods of

contraception at all.

(5)  Health insurance policies that fail to cover

prescription contraception and related medical and counseling

services discriminate against women and place effective forms

of contraception beyond the financial reach of many families.

Women of reproductive age spend 68% more than men on out-of-

pocket health care costs. Contraceptive drugs, devices and

related medical and counseling services account for much of

this difference.

(6)  At least 23 states have enacted laws to address the

inequity in prescription coverage caused by exclusion of

contraceptives. Women in this Commonwealth also deserve this

protection.

(7)  The Equal Employment Opportunity Commission ruled in

2000 that employers may not discriminate against women in

their health insurance plans by denying benefits for

prescription contraceptives if they provide benefits for

drugs, devices and services used to prevent other medical

conditions. On June 12, 2001, a Federal district court ruled

in Erickson v. Bartell Drug Company that an employer's

exclusion of prescription contraception from a health plan

that covers other prescription drugs and devices is illegal

sex discrimination in violation of Title VII of the Civil

Rights Act of 1964 (Public Law 88-352, 78 Stat. 241), as

amended by the act of October 31, 1978 (Public Law 95-555, 92

Stat. 2076), referred to as the Pregnancy Discrimination Act.

(8)  Following the inclusion of contraceptive coverage in

the Federal Employees Health Benefits Program in 1999, the

United States Office of Personnel Management reported that no

increased cost had been incurred as a result of the added

coverage.

(9)  This act affects the business of insurance. The

requirements of this act govern entities within the insurance

industry that provide health insurance policies as defined by

this act. The provisions of this act transfer and spread an

insured's risk and are an integral part of the policy

relationship between the insurer and the insured.

Section 3.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Health insurance policy."

(1)  Any individual or group health insurance policy,

contract or plan with coverage for prescription drugs that

provides medical coverage on an expense-incurred service or

prepaid basis issued by an entity subject to any one of the

following:

(i)  The act of May 17, 1921 (P.L.682, No.284), known

as The Insurance Company Law of 1921.

(ii)  Subarticle (f) of Article IV of the act of June

13, 1967 (P.L.31, No.21), known as the Public Welfare

Code.

(iii)  The act of December 29, 1972 (P.L.1701, No.

364), known as the Health Maintenance Organization Act.

(iv)  The act of May 18, 1976 (P.L.123, No.54), known

as the Individual Accident and Sickness Insurance Minimum

Standards Act.

(v)  40 Pa.C.S. Ch. 61 (relating to hospital plan

corporations) or 63 (relating to professional health

services plan corporations).

(2)  The term does not include any of the following types

of insurance or a combination of any of the following types

of insurance:

(i)  Short-term travel.

(ii)  Accident-only.

(iii)  Workers' compensation.

(iv)  Short-term nonrenewable policies of not more

than six months' duration.

(v)  Hospital indemnity.

(vi)  Specified disease.

(vii)  Disability income.

(viii)  Dental.

(ix)  Vision.

(x)  Civilian Health and Medical Program of the

Uniformed Services (CHAMPUS) supplement.

(xi)  Medicare or Medicaid supplemental contract.

(xii)  Long-term care.

(xiii)  Limited coverage accident and sickness

policy. This subparagraph includes cancer insurance,

polio insurance and any similar policy identified as

exempt from this section by the Insurance Commissioner.

"Limitation."  Any copayment, deductible or other cost-

sharing mechanism or premium differential.

"Outpatient medical or counseling service necessary for the

effective use of contraception."  The term includes, but is not

limited to, examinations, procedures and medical and counseling

services provided on an outpatient basis and services for

initial and periodic comprehensive physical examinations,

medical, laboratory and radiology services warranted by the

initial and periodic examinations or by the history, physical

findings or risk factors, including medical services necessary

for the insertion and removal of any contraceptive drug or

device and individual or group family planning counseling.

"Prescription contraceptive device."  Any regimen of a

prescription contraceptive device approved by the Food and Drug

Administration, as well as any generic equivalent approved as

substitutable by the Food and Drug Administration.

"Prescription contraceptive drug."  Any regimen of a

prescription contraceptive drug approved by the Food and Drug

Administration, as well as any generic equivalent approved as

substitutable by the Food and Drug Administration.

Section 4.  Mandated coverage.

(a)  General rule.--A health insurance policy that is

delivered, issued for delivery, renewed, extended or modified in

this Commonwealth on or after the effective date of this act

shall provide that the health insurance benefits applicable

under the policy include coverage for:

(1)  Any prescription contraceptive drug, if the policy

provides coverage for other prescription drugs.

(2)  Any prescription contraceptive device, if the policy

provides coverage for other prescription devices.

(3)  Any outpatient medical or counseling service

necessary for the effective use of contraception, if the

policy provides coverage for other outpatient medical or

counseling services.

(b)  Exceptions.--Nothing in this act shall be construed to

prevent a health insurance policy from imposing a limitation in

relation to any of the following, provided that the limitation

for this coverage is not greater than or different from all

other limitations imposed under general terms and conditions

under the policy:

(1)  Coverage for prescription contraceptive drugs.

(2)  Coverage for prescription contraceptive devices.

(3)  Coverage for outpatient medical or counseling

services necessary for the effective use of contraception.

Section 5.  Effective date.

This act shall take effect in 180 days.