PRINTER'S NO. 4103

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

2679

Session of

2018

INTRODUCED BY BOYLE, KRUEGER-BRANEKY, DAVIS, DEAN, SCHLOSSBERG,

THOMAS, SIMS, HILL-EVANS, GALLOWAY, RABB, McCARTER, FRANKEL,

DAVIDSON, DALEY, KINSEY, STURLA, BRIGGS, SOLOMON, ROZZI,

insurance companies, and the regulation, supervision, and

protection of home and foreign insurance companies, Lloyds

associations, reciprocal and inter-insurance exchanges, and

fire insurance rating bureaus, and the regulation and

supervision of insurance carried by such companies,

associations, and exchanges, including insurance carried by

the State Workmen's Insurance Fund; providing penalties; and

repealing existing laws," in casualty insurance, providing

for prior authorization, copayment, coinsurance and

dispensing requirements for contraceptive drugs, devices,

as The Insurance Company Law of 1921, is amended by adding

sections to read:

Section 635.8. Prior Authorization, Copayment, Coinsurance

and Dispensing Requirements for Contraceptive Drugs, Devices,

Products and Related Medical or Counseling Services.--(a) The

following shall apply regarding coverage:

(1) Subject to paragraphs (2) and (3), an insurer that

issues, delivers or renews a health insurance policy in this

Commonwealth on or after the effective date of this section

shall provide coverage for all FDA-approved contraceptive drugs,

(3) The following shall apply to a religious employer:

(i) Subject to subparagraph (iii), a religious employer may

request and an insurer shall grant the request for an exclusion

from coverage under a health insurance policy for coverage of an

FDA-approved contraceptive drug, device, product or related

medical or counseling service which is contrary to the

employer's religious tenets if the employer:

(A) is a not-for-profit organization that has the purpose of

inculcating religious values;

(B) primarily employs individuals who share the religious

related medical or counseling services which the employer

refuses to cover for religious reasons.

(iii) The exclusion from coverage under this paragraph shall

not apply to an FDA-approved contraceptive drug, device, product

or related medical or counseling service which is used for

purposes other than birth control.

(b) An insurer may not impose any restriction or delay on

(i) obtained under a prescription written by an authorized

prescriber, including for purposes other than birth control or

which are necessary to preserve the life or health of an

insured; or

(ii) for medical or counseling services which are necessary

for the effective use of contraception.

(c) The following shall apply regarding a cost-sharing

mechanism requirement:

(1) Except as provided in paragraph (2), an insurer may not

apply a copayment, coinsurance, deductible or another cost-

for the effective use of contraception.

(2) An insurer may apply a copayment, coinsurance,

deductible or another cost-sharing mechanism requirement for a

contraceptive drug, device or product that, according to the

FDA, is a therapeutic equivalent to another contraceptive drug,

device or product that is available under the same policy or

contract without a copayment, coinsurance or deductible, if the

medical or personal history, the health insurance policy shall

also provide coverage for another FDA-approved, medically

appropriate prescription contraceptive method prescribed by the

insured's provider without a copayment, coinsurance, deductible

or another cost-sharing mechanism.

(d) The following shall apply regarding dispensing:

(1) Except as provided in paragraph (2), an insurer shall

provide coverage for a single dispensing to an insured of a

supply of prescription contraceptives for up to a twelve-month

period.

product at one time.

(e) An insurer:

(1) Shall provide coverage without a prescription for all

contraceptive drugs, devices and products approved by the FDA

and available by prescription and over the counter.

(2) May not apply a copayment, coinsurance, deductible or

another cost-sharing requirement for a contraceptive drug

an insurer in violation of this act may file any of the

following:

(i) A complaint with the Insurance Commissioner, who shall

handle the complaint consistent with 2 Pa.C.S. (relating to

administrative law and procedure) and address a violation

through means appropriate to the nature and extent of the

violation, which may include a cease and desist order,

injunctive relief, restitution, suspension or revocation of a

certificate of authority or license, civil penalties,

reimbursement of costs or reasonable attorney fees incurred by

the costs of suit, reasonable attorney fees and reasonable fees

for the aggrieved individual's expert witnesses. At any time

prior to the rendering of final judgment, the aggrieved

individual may elect to recover, in lieu of actual damages, an

award of statutory damages in the amount of five thousand

dollars ($5,000) for each violation.

(g) As used in this section:

"Health insurance policy" means:

(1) An individual or group health insurance policy,

subscriber contract, certificate or plan which provides medical

or health care coverage by a health care facility or licensed

health care provider which is offered by or is governed under

this act or any of the following:

(i) Subarticle (f) of Article IV of the act of June 13, 1967

(P.L.31, No.21), known as the "Human Services Code."

(ii) The act of December 29, 1972 (P.L.1701, No.364), known

as the "Health Maintenance Organization Act."

(i) A health benefit plan that is a grandfathered health

plan, as defined in section 1251 of the Patient Protection and

Affordable Care Act (Public Law 111-148, 42 U.S.C. § 18011).

(ii) Any of the following types of insurance or a

combination of any of the following types of insurance:

(A) Accident only.

(B) Fixed indemnity.

(I) Civilian Health and Medical Program of the Uniformed

Services (CHAMPUS) supplement.

(J) Long-term care or disability income.

(K) Workers' compensation.

(L) Automobile medical payment.

"Insurer" means an entity that issues an individual or group

health insurance policy.

"Medical or counseling services" include, but are not limited

to:

(1) Examinations, procedures and medical and counseling

initial and periodic comprehensive physical examinations or by

the history, physical findings or risk factors, including

medical services necessary for the insertion and removal of any

contraceptive drug, device or product and individual or group

family planning counseling.

"P rescription contraceptive drug, device or product" includes

all regimes of over-the-counter and prescription contraceptive

safety profile when administered to a patient under the

conditions specified in the labeling;

(2) is FDA-approved as safe and effective;

(3) is a pharmaceutical equivalent in that it:

(i) contains identical amounts of the same active drug

ingredient in the same dosage form and route of administration;

and

(ii) meets compendial or other applicable standards of

strength, quality, purity and identity;

(4) is bioequivalent in that it:

Section 635.9. Coverage for Voluntary Male Sterilization.--

(a) The following shall apply regarding coverage:

(1) Subject to paragraphs (2) and (3), an insurer that

issues, delivers or renews a health insurance policy in this

Commonwealth on or after the effective date of this section

shall provide coverage for voluntary male sterilization in

accordance with the provisions of this section.

insurance policy for coverage of an FDA-approved contraceptive

drug, device, product or related medical or counseling service

which is contrary to the employer's religious tenets if the

employer:

(A) is a not-for-profit organization that has the purpose of

inculcating religious values;

(B) primarily employs individuals who share the religious

tenets of the employer; and

(C) primarily serves individuals who share the religious

tenets of the employer.

sterilization under a health insurance policy that is issued,

delivered or renewed in this Commonwealth on or after the