NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A585A REVISED MEMO 01/23/2019
SPONSOR: Cahill (MS) TITLE OF BILL: An act to amend the insurance law and the social
services law, in relation to requiring health insurance policies to
include coverage of all FDA-approved contraceptive drugs, devices, and
products, as well as voluntary sterilization procedures, contraceptive
education and counseling, and related follow up services and prohibiting
a health insurance policy from imposing any cost-sharing requirements or
other restrictions or delays with respect to this coverage
PURPOSE:
This legislation will help to reduce the number of unintended pregnan-
cies, improve birth outcomes and improve the health and welfare of New
Yorkers by ensuring that individuals have timely access to contraception
and the information they need in order to plan their families and their
future.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1. Provides that the act shall be known and may be cited as the
Comprehensive Contraception Coverage Act.
Section 2. Amends paragraph 16 of subsection (1) of section 3221 of the
insurance law to require commercial group health insurance policies to
cover all FDA-approved contraceptive drugs, devices and products when
prescribed by a health care provider.
When the FDA has approved one or more therapeutic and pharmaceutical
equivalent versions of a contraceptive drug, device or product, coverage
is not required for equivalent versions of the contraceptive drug unless
the equivalent is not available or is medically inadvisable. Coverage
shall: (i) include emergency contraception when prescribed, when avail-
able through section 6831 of the education law or when lawfully provided
over the counter; (ii) allow for dispensing of up to twelve months of
contraception; (iii) include voluntary sterilization procedures for
women and men; (iv) include patient education and counseling about
contraception; and (v) include any follow-up care related to the covered
contraceptives including management of side-effects, counseling and
device insertion and removal.
An insurer may not apply co-pays or deductibles when coverage for a
contraceptive method is required. In addition, no restrictions, or
delays in coverage can be applied when coverage for a contraceptive
method is required. Coverage for an enrollee's covered spouse, domestic
partner and covered dependents shall be the same as for the enrollee.
The Department of Financial Services shall promulgate regulations estab-
lishing a process for an insured or an insured's health care provider to
request coverage of a non-covered contraceptive drug, device or product.
"Conscience protections" in existing law remain untouched. Specif-
ically; the bill does not amend existing law which allows a religious
employer to request an insurance policy without coverage for FDA-ap-
proved contraceptive methods that are contrary to the religious employ-
er's religious tenets.
Sections 3 and 4. Makes similar changes outlined in Section 2 to
subsection (cc) of Section 4303 of the insurance law relating to nonpro-
fit medical indemnity, or health and hospital service corporations and
subparagraph (E) of paragraph 17 of subsection (i) of section 3216 of
the insurance law relating to individual health insurance policies.
Section 5. Amends paragraph (d) of subdivision 3 of section 365-a of the
social services law to clarify that Medicaid coverage of contraceptives
shall include a twelve-month supply that can be filled at one time or up
to twelve times within one year from the date of the prescription.
Section 6. Provides that this act shall take effect January 1, 2020.
JUSTIFICATION:
Access to contraceptive services is essential to women's health and
equality. New York has long recognized the central role that contracep-
tion plays in women's health and lives and has led efforts to expand
access to contraception. All New Yorkers, regardless of economic status,
should have timely access to contraception and the information they need
in order to protect their health, plan their families and their future.
Time and time again, studies show that contraceptive access reduces
rates of unintended pregnancy, plays a crucial role in improving public
health outcomes, as well as improving the economic well-being of women
and their families.* However, despite legal reform on the State and
Federal level, lack of contraceptive insurance coverage and high co-pay-
ments remain significant barriers to contraceptive access.
The Contraceptive Equity Act would amend state insurance and social
service laws to require health insurance policies to include coverage of
all Food and Drug Administration (FDA) approved contraceptive drugs,
devices, and products, as well as voluntary sterilization procedures,
contraceptive education and counseling, and related follow up
services.** It would also prohibit a health insurance policy from impos-
ing any cost-sharing requirements or other restriction or delays with
respect to this coverage.
In 2002, the New York State Legislature passed the Women's Health and
Wellness Act, an important first step toward contraceptive equity that
required insurance plans that cover prescriptions to include contracep-
tion. Eight years later, the U.S. Congress passed the Affordable Care
Act (ACA), which includes a contraceptive coverage guarantee as part of
a broader requirement for health insurance plans to cover contraceptive
services without cost-sharing for all women in the Health Insurance
Marketplace.
The contraceptive equity policy is one of the landmark achievements of
the ACA, but a lack of clarity in the federal law has led to inconsist-
ent implementation and enforcement. Insurers can take advantage of this
confusion to limit coverage for the diverse array of contraceptive meth-
ods available and, in some cases, can prevent individuals from accessing
the method deemed most effective by their medical provider: Addi-
tionally, many insurance companies do not typically cover male methods
of contraception or require high cost-sharing despite the critical role
men play in the prevention of unintended pregnancy.
Building on existing state and federal law to promote gender equity and
women's health, this Act would ensure broad contraceptive coverage and
timely access to all federal FDA-approved methods of contraception for
individuals covered under health insurance plans in New York.
PRIOR LEGISLATIVE HISTORY:
2018: A.9957 - Passed Assembly
2017: A.1378 - Passed Assembly
2015-2016: A.8135B - Passed Assembly
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None.
EFFECTIVE DATE:
*Bonfield, Adam. "What Women Already Know: Documenting the Social and
Economic Benefits of Family Planning." Guttmacher Institute. Winter
2013. http://www. guttmacher. org/pubs/gpr/ 16/1/gpr160108.html
**For a full list of these devices, see the FDA Office of Women's
Health's Birth Control Guide http://Wwm.fda.gov/ downloads/ForConsumers/
ByAudience/ForWomen/ FreePublications/UCM 356451.pdf This act shall take
effect on January 1, 2020.
STATE OF NEW YORK
________________________________________________________________________
S. 659--A A. 585--A
2019-2020 Regular Sessions
SENATE - ASSEMBLY(Prefiled)
January 9, 2019
___________
IN SENATE -- Introduced by Sens. SALAZAR, METZGER, ADDABBO, BAILEY,
BENJAMIN, BIAGGI, BRESLIN, BROOKS, CARLUCCI, COMRIE, GAUGHRAN, GIANAR-
IS, GOUNARDES, HARCKHAM, HOYLMAN, JACKSON, KAMINSKY, KAPLAN, KAVANAGH,
KENNEDY, KRUEGER, LIU, MARTINEZ, MAY, MAYER, MONTGOMERY, MYRIE, PARK-
ER, PERSAUD, RAMOS, RIVERA, SANDERS, SAVINO, SEPULVEDA, SERRANO,
SKOUFIS, STAVISKY, STEWART-COUSINS, THOMAS -- read twice and ordered
printed, and when printed to be committed to the Committee on Insur-
ance -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee
IN ASSEMBLY -- Introduced by M. of A. CAHILL, SEAWRIGHT, HEASTIE,
L. ROSENTHAL, GLICK, JAFFEE, SIMOTAS, GOTTFRIED, BARRON, BLAKE,
BARRETT, MAGNARELLI, BRONSON, LAVINE, CARROLL, GALEF, OTIS, SIMON,
HYNDMAN, RAMOS, D'URSO, PEOPLES-STOKES, PICHARDO, ORTIZ, WOERNER,
BURKE, CRUZ, FALL, FRONTUS, GRIFFIN, JACOBSON, McMAHON, RAYNOR, ROMEO,
REYES, SAYEGH -- Multi-Sponsored by -- M. of A. BRAUNSTEIN, BUCHWALD,
COOK, EPSTEIN, LIFTON, LUPARDO, MOSLEY, ROZIC, THIELE, TITUS -- read
once and referred to the Committee on Insurance -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the insurance law and the social services law, in
relation to requiring health insurance policies to include coverage of
all FDA-approved contraceptive drugs, devices, and products, as well
as voluntary sterilization procedures, contraceptive education and
counseling, and related follow up services and prohibiting a health
insurance policy from imposing any cost-sharing requirements or other
restrictions or delays with respect to this coverage
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD06618-04-9
S. 659--A 2 A. 585--A
1 Section 1. This act shall be known and may be cited as the "comprehen-
2 sive contraception coverage act".
3 § 2. Paragraph 16 of subsection (l) of section 3221 of the insurance
4 law, as added by chapter 554 of the laws of 2002, is amended to read as
5 follows:
6 (16) (A) Every group or blanket policy [which provides coverage for
7 prescription drugs shall include coverage for the cost of contraceptive
8 drugs or devices approved by the federal food and drug administration or
9 generic equivalents approved as substitutes by such food and drug admin-
10 istration under the prescription of a health care provider legally
11 authorized to prescribe under title eight of the education law. The
12 coverage required by this section shall be included in policies and
13 certificates only through the addition of a rider.
14 (A)] that is issued, amended, renewed, effective or delivered on or
15 after January first, two thousand twenty, shall provide coverage for all
16 of the following services and contraceptive methods:
17 (1) All FDA-approved contraceptive drugs, devices, and other products.
18 This includes all FDA-approved over-the-counter contraceptive drugs,
19 devices, and products as prescribed or as otherwise authorized under
20 state or federal law. The following applies to this coverage:
21 (a) where the FDA has approved one or more therapeutic and pharmaceu-
22 tical equivalent, as defined by the FDA, versions of a contraceptive
23 drug, device, or product, a group or blanket policy is not required to
24 include all such therapeutic and pharmaceutical equivalent versions in
25 its formulary, so long as at least one is included and covered without
26 cost-sharing and in accordance with this paragraph;
27 (b) if the covered therapeutic and pharmaceutical equivalent versions
28 of a drug, device, or product are not available or are deemed medically
29 inadvisable a group or blanket policy shall provide coverage for an
30 alternate therapeutic and pharmaceutical equivalent version of the
31 contraceptive drug, device, or product without cost-sharing. If the
32 attending health care provider, in his or her reasonable professional
33 judgment, determines that the use of a non-covered therapeutic or phar-
34 maceutical equivalent of a drug, device, or product is warranted, the
35 health care provider's determination shall be final. The superintendent
36 shall promulgate regulations establishing a process, including time-
37 frames, for an insured, an insured's designee or an insured's health
38 care provider to request coverage of a non-covered contraceptive drug,
39 device, or product. Such regulations shall include a requirement that
40 insurers use an exception form that shall meet criteria established by
41 the superintendent;
42 (c) this coverage shall include emergency contraception without cost-
43 sharing when provided pursuant to a prescription or order under section
44 sixty-eight hundred thirty-one of the education law or when lawfully
45 provided over the counter; and
46 (d) this coverage must allow for the dispensing of up to twelve months
47 worth of a contraceptive at one time;
48 (2) Voluntary sterilization procedures;
49 (3) Patient education and counseling on contraception; and
50 (4) Follow-up services related to the drugs, devices, products, and
51 procedures covered under this paragraph, including, but not limited to,
52 management of side effects, counseling for continued adherence, and
53 device insertion and removal.
54 (B) A group or blanket policy subject to this paragraph shall not
55 impose a deductible, coinsurance, copayment, or any other cost-sharing
56 requirement on the coverage provided pursuant to this paragraph.
S. 659--A 3 A. 585--A
1 (C) Except as otherwise authorized under this paragraph, a group or
2 blanket policy shall not impose any restrictions or delays on the cover-
3 age required under this paragraph.
4 (D) Benefits for an enrollee under this paragraph shall be the same
5 for an enrollee's covered spouse or domestic partner and covered
6 nonspouse dependents.
7 (E) Notwithstanding any other provision of this subsection, a reli-
8 gious employer may request a contract without coverage for federal food
9 and drug administration approved contraceptive methods that are contrary
10 to the religious employer's religious tenets. If so requested, such
11 contract shall be provided without coverage for contraceptive methods.
12 This paragraph shall not be construed to deny an enrollee coverage of,
13 and timely access to, contraceptive methods.
14 (1) For purposes of this subsection, a "religious employer" is an
15 entity for which each of the following is true:
16 (a) The inculcation of religious values is the purpose of the entity.
17 (b) The entity primarily employs persons who share the religious
18 tenets of the entity.
19 (c) The entity serves primarily persons who share the religious tenets
20 of the entity.
21 (d) The entity is a nonprofit organization as described in Section
22 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
23 (2) Every religious employer that invokes the exemption provided under
24 this paragraph shall provide written notice to prospective enrollees
25 prior to enrollment with the plan, listing the contraceptive health care
26 services the employer refuses to cover for religious reasons.
27 [(B) (i)] (F) (1) Where a group policyholder makes an election not to
28 purchase coverage for contraceptive drugs or devices in accordance with
29 subparagraph [(A)] (E) of this paragraph each certificateholder covered
30 under the policy issued to that group policyholder shall have the right
31 to directly purchase the rider required by this paragraph from the
32 insurer which issued the group policy at the prevailing small group
33 community rate for such rider whether or not the employee is part of a
34 small group.
35 [(ii)] (2) Where a group policyholder makes an election not to
36 purchase coverage for contraceptive drugs or devices in accordance with
37 subparagraph [(A)] (E) of this paragraph, the insurer that provides such
38 coverage shall provide written notice to certificateholders upon enroll-
39 ment with the insurer of their right to directly purchase a rider for
40 coverage for the cost of contraceptive drugs or devices. The notice
41 shall also advise the certificateholders of the additional premium for
42 such coverage.
43 [(C)] (G) Nothing in this paragraph shall be construed as authorizing
44 a group or blanket policy which provides coverage for prescription drugs
45 to exclude coverage for prescription drugs prescribed for reasons other
46 than contraceptive purposes.
47 [(D) Such coverage may be subject to reasonable annual deductibles and
48 coinsurance as may be deemed appropriate by the superintendent and as
49 are consistent with those established for other drugs or devices covered
50 under the policy.]
51 § 3. Subsection (cc) of section 4303 of the insurance law, as added by
52 chapter 554 of the laws of 2002, is amended to read as follows:
53 (cc) (1) Every contract [which provides coverage for prescription
54 drugs shall include coverage for the cost of contraceptive drugs or
55 devices approved by the federal food and drug administration or generic
56 equivalents approved as substitutes by such food and drug administration
S. 659--A 4 A. 585--A
1 under the prescription of a health care provider legally authorized to
2 prescribe under title eight of the education law. The coverage required
3 by this section shall be included in contracts and certificates only
4 through the addition of a rider.
5 (1)] that is issued, amended, renewed, effective or delivered on or
6 after January first, two thousand twenty, shall provide coverage for all
7 of the following services and contraceptive methods:
8 (A) All FDA-approved contraceptive drugs, devices, and other products.
9 This includes all FDA-approved over-the-counter contraceptive drugs,
10 devices, and products as prescribed or as otherwise authorized under
11 state or federal law. The following applies to this coverage:
12 (i) where the FDA has approved one or more therapeutic and pharmaceu-
13 tical equivalent, as defined by the FDA, versions of a contraceptive
14 drug, device, or product, a contract is not required to include all such
15 therapeutic and pharmaceutical equivalent versions in its formulary, so
16 long as at least one is included and covered without cost-sharing and in
17 accordance with this subsection;
18 (ii) if the covered therapeutic and pharmaceutical equivalent versions
19 of a drug, device, or product are not available or are deemed medically
20 inadvisable a contract shall provide coverage for an alternate therapeu-
21 tic and pharmaceutical equivalent version of the contraceptive drug,
22 device, or product without cost-sharing. If the attending health care
23 provider, in his or her reasonable professional judgment, determines
24 that the use of a non-covered therapeutic or pharmaceutical equivalent
25 of a drug, device, or product is warranted, the health care provider's
26 determination shall be final. The superintendent shall promulgate regu-
27 lations establishing a process, including timeframes, for an insured, an
28 insured's designee or an insured's health care provider to request
29 coverage of a non-covered contraceptive drug, device, or product. Such
30 regulations shall include a requirement that insurers use an exception
31 form that shall meet criteria established by the superintendent;
32 (iii) this coverage shall include emergency contraception without
33 cost-sharing when provided pursuant to a prescription or order under
34 section sixty-eight hundred thirty-one of the education law or when
35 lawfully provided over the counter; and
36 (iv) this coverage must allow for the dispensing of up to twelve
37 months worth of a contraceptive at one time;
38 (B) Voluntary sterilization procedures;
39 (C) Patient education and counseling on contraception; and
40 (D) Follow-up services related to the drugs, devices, products, and
41 procedures covered under this subsection, including, but not limited to,
42 management of side effects, counseling for continued adherence, and
43 device insertion and removal.
44 (2) A contract subject to this subsection shall not impose a deduct-
45 ible, coinsurance, copayment, or any other cost-sharing requirement on
46 the coverage provided pursuant to this subsection.
47 (3) Except as otherwise authorized under this subsection, a contract
48 shall not impose any restrictions or delays on the coverage required
49 under this subsection.
50 (4) Benefits for an enrollee under this subsection shall be the same
51 for an enrollee's covered spouse or domestic partner and covered
52 nonspouse dependents.
53 (5) Notwithstanding any other provision of this subsection, a reli-
54 gious employer may request a contract without coverage for federal food
55 and drug administration approved contraceptive methods that are contrary
56 to the religious employer's religious tenets. If so requested, such
S. 659--A 5 A. 585--A
1 contract shall be provided without coverage for contraceptive methods.
2 This paragraph shall not be construed to deny an enrollee coverage of,
3 and timely access to, contraceptive methods.
4 (A) For purposes of this subsection, a "religious employer" is an
5 entity for which each of the following is true:
6 (i) The inculcation of religious values is the purpose of the entity.
7 (ii) The entity primarily employs persons who share the religious
8 tenets of the entity.
9 (iii) The entity serves primarily persons who share the religious
10 tenets of the entity.
11 (iv) The entity is a nonprofit organization as described in Section
12 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
13 (B) Every religious employer that invokes the exemption provided under
14 this paragraph shall provide written notice to prospective enrollees
15 prior to enrollment with the plan, listing the contraceptive health care
16 services the employer refuses to cover for religious reasons.
17 [(2)](6) (A) Where a group contractholder makes an election not to
18 purchase coverage for contraceptive drugs or devices in accordance with
19 paragraph [one] five of this subsection, each enrollee covered under the
20 contract issued to that group contractholder shall have the right to
21 directly purchase the rider required by this subsection from the insurer
22 or health maintenance organization which issued the group contract at
23 the prevailing small group community rate for such rider whether or not
24 the employee is part of a small group.
25 (B) Where a group contractholder makes an election not to purchase
26 coverage for contraceptive drugs or devices in accordance with paragraph
27 [one] five of this subsection, the insurer or health maintenance organ-
28 ization that provides such coverage shall provide written notice to
29 enrollees upon enrollment with the insurer or health maintenance organ-
30 ization of their right to directly purchase a rider for coverage for the
31 cost of contraceptive drugs or devices. The notice shall also advise the
32 enrollees of the additional premium for such coverage.
33 [(3)](7) Nothing in this subsection shall be construed as authorizing
34 a contract which provides coverage for prescription drugs to exclude
35 coverage for prescription drugs prescribed for reasons other than
36 contraceptive purposes.
37 [(4) Such coverage may be subject to reasonable annual deductibles and
38 coinsurance as may be deemed appropriate by the superintendent and as
39 are consistent with those established for other drugs or devices covered
40 under the policy.]
41 § 4. Subparagraph (E) of paragraph 17 of subsection (i) of section
42 3216 of the insurance law is amended by adding a new clause (v) to read
43 as follows:
44 (v) all FDA-approved contraceptive drugs, devices, and other products,
45 including all over-the-counter contraceptive drugs, devices, and
46 products as prescribed or as otherwise authorized under state or federal
47 law; voluntary sterilization procedures; patient education and coun-
48 seling on contraception; and follow-up services related to the drugs,
49 devices, products, and procedures covered under this clause, including,
50 but not limited to, management of side effects, counseling for continued
51 adherence, and device insertion and removal. Except as otherwise author-
52 ized under this clause, a contract shall not impose any restrictions or
53 delays on the coverage required under this clause. However, where the
54 FDA has approved one or more therapeutic and pharmaceutical equivalent,
55 as defined by the FDA, versions of a contraceptive drug, device, or
56 product, a contract is not required to include all such therapeutic and
S. 659--A 6 A. 585--A
1 pharmaceutical equivalent versions in its formulary, so long as at least
2 one is included and covered without cost-sharing and in accordance with
3 this clause. If the covered therapeutic and pharmaceutical equivalent
4 versions of a drug, device, or product are not available or are deemed
5 medically inadvisable a contract shall provide coverage for an alternate
6 therapeutic and pharmaceutical equivalent version of the contraceptive
7 drug, device, or product without cost-sharing. (a) This coverage shall
8 include emergency contraception without cost sharing when provided
9 pursuant to a prescription, or order under section sixty-eight hundred
10 thirty-one of the education law or when lawfully provided over-the-coun-
11 ter. (b) If the attending health care provider, in his or her reason-
12 able professional judgment, determines that the use of a non-covered
13 therapeutic or pharmaceutical equivalent of a drug, device, or product
14 is warranted, the health care provider's determination shall be final.
15 The superintendent shall promulgate regulations establishing a process,
16 including timeframes, for an insured, an insured's designee or an
17 insured's health care provider to request coverage of a non-covered
18 contraceptive drug, device, or product. Such regulations shall include a
19 requirement that insurers use an exception form that shall meet criteria
20 established by the superintendent. (c) This coverage must allow for the
21 dispensing of up to twelve months worth of a contraceptive at one time.
22 § 5. Paragraph (d) of subdivision 3 of section 365-a of the social
23 services law, as amended by chapter 909 of the laws of 1974 and as
24 relettered by chapter 82 of the laws of 1995, is amended to read as
25 follows:
26 (d) family planning services and twelve months of supplies for eligi-
27 ble persons of childbearing age, including children under twenty-one
28 years of age who can be considered sexually active, who desire such
29 services and supplies, in accordance with the requirements of federal
30 law and regulations and the regulations of the department. Coverage of
31 prescription contraceptives shall include a twelve-month supply that may
32 be dispensed at one time or up to twelve times within one year from the
33 date of the prescription. No person shall be compelled or coerced to
34 accept such services or supplies.
35 § 6. This act shall take effect January 1, 2020.
