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S00659 Summary:

BILL NOS00659A
 
SAME ASSAME AS UNI. A00585-A
 
SPONSORSALAZAR
 
COSPNSRMETZGER, ADDABBO, BAILEY, BENJAMIN, BIAGGI, BRESLIN, BROOKS, CARLUCCI, COMRIE, GAUGHRAN, GIANARIS, GOUNARDES, HARCKHAM, HOYLMAN, JACKSON, KAMINSKY, KAPLAN, KAVANAGH, KENNEDY, KRUEGER, LIU, MARTINEZ, MAY, MAYER, MONTGOMERY, MYRIE, PARKER, PERSAUD, RAMOS, RIVERA, SANDERS, SAVINO, SEPULVEDA, SERRANO, SKOUFIS, STAVISKY, STEWART-COUSINS, THOMAS
 
MLTSPNSR
 
Amd 3221, 4303 & 3216, Ins L; amd 365-a, Soc Serv L
 
Enacts the "comprehensive contraception coverage act" to provide insurance coverage for FDA-approved contraceptive drugs, devices and products.
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S00659 Actions:

BILL NOS00659A
 
01/09/2019REFERRED TO INSURANCE
01/11/2019AMEND (T) AND RECOMMIT TO INSURANCE
01/11/2019PRINT NUMBER 659A
01/22/2019REPORTED AND COMMITTED TO RULES
01/22/2019ORDERED TO THIRD READING CAL.34
01/22/2019PASSED SENATE
01/22/2019DELIVERED TO ASSEMBLY
01/22/2019referred to codes
01/22/2019substituted for a585a
01/22/2019ordered to third reading cal.8
01/22/2019passed assembly
01/22/2019returned to senate
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S00659 Text:



 
                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.
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