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                                                       PRINTER'S NO. 357



No. 316 Session of 2007


           FEBRUARY 7, 2007

                                     AN ACT

     1  To ensure equitable coverage of prescription contraceptive drugs
     2     and devices and the medical and counseling services necessary
     3     for their effective use.

     4     The General Assembly of the Commonwealth of Pennsylvania
     5  hereby enacts as follows:
     6  Section 1.  Short title.
     7     This act shall be known and may be cited as the Prescription
     8  Contraception Equity Act.
     9  Section 2.  Findings.
    10     The General Assembly finds and declares as follows:
    11         (1)  Each year, more than 3,000,000 women face an
    12     unintended pregnancy, representing nearly half of all
    13     pregnancies in the United States.
    14         (2)  By reducing rates of unintended pregnancy,
    15     contraception improves women's health and well-being, reduces
    16     infant morbidity and mortality and reduces the need for
    17     abortion.

     1         (3)  The cost of adding insurance coverage for all FDA-
     2     approved contraception and related medical and counseling
     3     services has been estimated at less than $2 per employee per
     4     month.
     5         (4)  Most insurance policies cover prescription drugs and
     6     devices and outpatient medical and counseling services but do
     7     not cover all methods of FDA-approved contraception and the
     8     medical and counseling services necessary for their effective
     9     use. Many policies cover no reversible methods of
    10     contraception at all.
    11         (5)  Health insurance policies that fail to cover
    12     prescription contraception and related medical and counseling
    13     services discriminate against women and place effective forms
    14     of contraception beyond the financial reach of many families.
    15     Women of reproductive age spend 68% more than men on out-of-
    16     pocket health care costs. Contraceptive drugs, devices and
    17     related medical and counseling services account for much of
    18     this difference.
    19         (6)  At least 23 states have enacted laws to address the
    20     inequity in prescription coverage caused by exclusion of
    21     contraceptives. Women in this Commonwealth also deserve this
    22     protection.
    23         (7)  The Equal Employment Opportunity Commission ruled in
    24     2000 that employers may not discriminate against women in
    25     their health insurance plans by denying benefits for
    26     prescription contraceptives if they provide benefits for
    27     drugs, devices and services used to prevent other medical
    28     conditions. On June 12, 2001, a Federal district court ruled
    29     in Erickson v. Bartell Drug Company that an employer's
    30     exclusion of prescription contraception from a health plan
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     1     that covers other prescription drugs and devices is illegal
     2     sex discrimination in violation of Title VII of the Civil
     3     Rights Act of 1964 (Public Law 88-352, 78 Stat. 241), as
     4     amended by the act of October 31, 1978 (Public Law 95-555, 92
     5     Stat. 2076), referred to as the Pregnancy Discrimination Act.
     6         (8)  Following the inclusion of contraceptive coverage in
     7     the Federal Employees Health Benefits Program in 1999, the
     8     United States Office of Personnel Management reported that no
     9     increased cost had been incurred as a result of the added
    10     coverage.
    11         (9)  This act affects the business of insurance. The
    12     requirements of this act govern entities within the insurance
    13     industry that provide health insurance policies as defined by
    14     this act. The provisions of this act transfer and spread an
    15     insured's risk and are an integral part of the policy
    16     relationship between the insurer and the insured.
    17  Section 3.  Definitions.
    18     The following words and phrases when used in this act shall
    19  have the meanings given to them in this section unless the
    20  context clearly indicates otherwise:
    21     "Health insurance policy."
    22         (1)  Any individual or group health insurance policy,
    23     contract or plan with coverage for prescription drugs that
    24     provides medical coverage on an expense-incurred service or
    25     prepaid basis issued by an entity subject to any one of the
    26     following:
    27             (i)  The act of May 17, 1921 (P.L.682, No.284), known
    28         as The Insurance Company Law of 1921.
    29             (ii)  Subarticle (f) of Article IV of the act of June
    30         13, 1967 (P.L.31, No.21), known as the Public Welfare
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     1         Code.
     2             (iii)  The act of December 29, 1972 (P.L.1701,
     3         No.364), known as the Health Maintenance Organization
     4         Act.
     5             (iv)  The act of May 18, 1976 (P.L.123, No.54), known
     6         as the Individual Accident and Sickness Insurance Minimum
     7         Standards Act.
     8             (v)  40 Pa.C.S. Ch. 61 (relating to hospital plan
     9         corporations) or 63 (relating to professional health
    10         services plan corporations).
    11         (2)  The term does not include any of the following types
    12     of insurance or a combination of any of the following types
    13     of insurance:
    14             (i)  Short-term travel.
    15             (ii)  Accident-only.
    16             (iii)  Workers' compensation.
    17             (iv)  Short-term nonrenewable policies of not more
    18         than six months' duration.
    19             (v)  Hospital indemnity.
    20             (vi)  Specified disease.
    21             (vii)  Disability income.
    22             (viii)  Dental.
    23             (ix)  Vision.
    24             (x)  Civilian Health and Medical Program of the
    25         Uniformed Services (CHAMPUS) supplement.
    26             (xi)  Medicare or Medicaid supplemental contract.
    27             (xii)  Long-term care.
    28             (xiii)  Limited coverage accident and sickness
    29         policy. This subparagraph includes cancer insurance,
    30         polio insurance and any similar policy identified as
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     1         exempt from this section by the Insurance Commissioner.
     2     "Limitation."  Any copayment, deductible or other cost-
     3  sharing mechanism or premium differential.
     4     "Outpatient medical or counseling service necessary for the
     5  effective use of contraception."  The term includes, but is not
     6  limited to, examinations, procedures and medical and counseling
     7  services provided on an outpatient basis and services for
     8  initial and periodic comprehensive physical examinations,
     9  medical, laboratory and radiology services warranted by the
    10  initial and periodic examinations or by the history, physical
    11  findings or risk factors, including medical services necessary
    12  for the insertion and removal of any contraceptive drug or
    13  device and individual or group family planning counseling.
    14     "Prescription contraceptive device."  Any regimen of a
    15  prescription contraceptive device approved by the Food and Drug
    16  Administration, as well as any generic equivalent approved as
    17  substitutable by the Food and Drug Administration.
    18     "Prescription contraceptive drug."  Any regimen of a
    19  prescription contraceptive drug approved by the Food and Drug
    20  Administration, as well as any generic equivalent approved as
    21  substitutable by the Food and Drug Administration.
    22  Section 4.  Mandated coverage.
    23     (a)  General rule.--A health insurance policy that is
    24  delivered, issued for delivery, renewed, extended or modified in
    25  this Commonwealth on or after the effective date of this act
    26  shall provide that the health insurance benefits applicable
    27  under the policy include coverage for:
    28         (1)  Any prescription contraceptive drug, if the policy
    29     provides coverage for other prescription drugs.
    30         (2)  Any prescription contraceptive device, if the policy
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     1     provides coverage for other prescription devices.
     2         (3)  Any outpatient medical or counseling service
     3     necessary for the effective use of contraception, if the
     4     policy provides coverage for other outpatient medical or
     5     counseling services.
     6     (b)  Exceptions.--Nothing in this act shall be construed to
     7  prevent a health insurance policy from imposing a limitation in
     8  relation to any of the following, provided that the limitation
     9  for this coverage is not greater than or different from all
    10  other limitations imposed under general terms and conditions
    11  under the policy:
    12         (1)  Coverage for prescription contraceptive drugs.
    13         (2)  Coverage for prescription contraceptive devices.
    14         (3)  Coverage for outpatient medical or counseling
    15     services necessary for the effective use of contraception.
    16  Section 5.  Effective date.
    17     This act shall take effect in 180 days.

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