Contraceptive Equity Laws in the States

A look at contraceptive equity laws around the country

A look at contraceptive equity laws around the country

 

Last update: January 4, 2006

Twenty-three states mandate some form of contraceptive equity.*

This document provides summaries of the relevant statutory provisions in those states that mandate some form of contraceptive equity. The summaries are not intended to provide exhaustive interpretations of state law; for precise details, the statutes themselves should be referenced.

Contraceptive equity laws impose requirements on insurers (i.e., health care organizations, hospitals, or health management organizations) that provide insurance on a group or individual basis, or on the plans they administer (i.e., the packages of benefits provided under insurance policies or contracts). The laws are concerned with the coverage of FDA-approved prescription contraceptive drugs and devices, and associated contraceptive services. Generally, if an insurer or plan covers other prescription drugs and/or outpatient services, it must also cover contraceptives and contraceptive services —and it must do so on comparable terms. Some state laws also mandate equal coverage of other additional services, such as hormone replacement therapy, bone density screenings, mammograms and so forth. (See states marked ± below).

A contraceptive equity law may include a loophole or "refusal clause" under which entities or individuals that can demonstrate a religious objection to contraceptives may escape the requirements.

Arizona

Year Passed: 2002
Effective Date: January 1, 2003


Requirements. Every insurer that covers prescription drugs must also cover prescribed contraceptive drugs or devices. If the insurer uses a drug formulary (a tiered list of preferred medications), the formulary must include oral, implant and injectable contraceptive drugs, intrauterine devices and prescription barrier methods, and the insurer may not impose greater deductibles, coinsurance or copayments on contraceptive drugs than on other drugs at the same level of the formulary. Likewise, every insurer that covers outpatient services must also cover outpatient contraceptive services.

Refusal clause. A religious employer whose religious tenets prohibit the use of prescribed contraceptive methods may require its insurer to exclude contraceptive methods from coverage. A "religious employer" is one that (1) primarily employs persons who share its religious tenets, (2) primarily serves persons who share its religious tenets, and (3) is a non-profit organization. In order invoke the refusal clause, the employer must submit to the insurer a written affidavit stating that it is a religious employer, and it must provide advance written notice to prospective enrollees.

Exceptions to refusal clause. A religious employer may not require its insurer to exclude coverage of contraceptives prescribed for noncontraceptive purposes. Furthermore, religious employers are prohibited from discriminating against employees who independently choose to obtain contraceptive coverage or contraceptive prescriptions from another source.

Arkansas

Year Passed: 2005
Effective Date: August 13, 2005


Requirements. Every health benefit policy that provides coverage for prescription drugs on an outpatient basis must also cover prescription contraception drugs or devices approved by the U.S. Food and Drug Administration. However, prescription emergency contraception is explicitly excluded from the coverage requirement, as are abortion and abortifacients. Insurers are not permitted to impose copayments, fees, or reduction in allowable reimbursements on women utilizing the contraceptive benefits if these are not equally imposed on all individuals in the same benefit or copayment level.

Refusal Clause. Nothing in this subchapter shall be construed to require any religious employer to comply with this subchapter. A religious employer is defined as an entity organized and operated for religious purposes that has received a Section 501(c) (3) designation from the I.R.S., that has inculcation of religious values as one of its primary purposes, and that employs primarily persons who share in its religious tenets.

Exceptions to refusal Clause. None

California

Year Passed: 1999
Effective Date: January 1, 2000


Requirements. Every group or individual insurance plan that covers outpatient prescription drug benefits must also cover "a variety of" prescription contraceptive methods. If a participating physician determines that none of the covered methods is medically appropriate for a particular patient, the plan must cover the alternative method prescribed by that physician. The coverage must also apply to the enrollee's spouse and dependents. Specialized health care plans are excluded from these requirements.

Refusal clause. A religious employer may obtain a plan that excludes coverage for contraceptives. A "religious employer" is an employer (1) whose purpose is the inculcation of religious values; (2) which primarily employs persons who share its religious tenets; (3) which primarily serves persons who share the religious tenets of the entity; and (4) which is a nonprofit organization. Such an employer must provide advance written notice to prospective enrollees, listing the contraceptive health care services the employer refuses to cover.

Exceptions to refusal clause. A plan may not exclude coverage of contraceptives prescribed for noncontraceptive purposes; however, a plan need not cover "experimental or investigational treatments."

Connecticut

Year Passed: 1999
Effective Date: October 1, 1999


Requirements. Every individual insurance plan that covers outpatient prescription drugs may not exclude coverage for prescription contraceptive methods.

Refusal clause. A religious employer may obtain a plan that excludes coverage for prescription contraceptive methods "which are contrary to the religious employer's bona fide religious tenets." A "religious employer" is defined as a "qualified church-controlled organization" under federal law, or a "church-affiliated organization." The employer must notify enrollees in writing that contraceptives are not covered under its plan. Likewise, an individual may obtain a plan that excludes coverage for prescription contraceptives upon written affirmation that contraceptives are contrary to the individual's religious or moral beliefs. Finally, an insurer which is owned or operated by a religious organization need not provide contraceptive coverage itself; it may provide such coverage through another insurer at the same cost, terms and availability.

Exceptions to refusal clause. No plan may exclude coverage for prescription drugs ordered by a physician for purposes other than contraception.

Delaware

Year Passed: 2000
Effective Date: June 7, 2000


Requirements. All group and blanket plans that cover prescription drugs must also cover, on comparable terms, prescription contraceptive drugs and devices. Such plans must also cover outpatient contraceptive services, and the insertion and removal and medically necessary examinations associated with the use of contraceptives. Coverage must extend to the enrollee and all parties covered by the plan.

Refusal clause. A religious employer is entitled to an exclusion from contraceptive coverage if such coverage conflicts with its "bona fide religious beliefs and practices." Such an employer must provide its employees "reasonable and timely notice" as to the exclusion. The term "religious employer" is not defined further under this section.

Exceptions to refusal clause.
None.

Georgia

Year Passed: 1999
Effective Date: July 1, 1999


Requirements. Any individual or group plan that covers prescription drugs on an outpatient basis must also cover any drug or device prescribed for use as a contraceptive. Copayments and coinsurance imposed on recipients of prescription contraceptive benefits may not differ from those imposed on recipients of other prescription drug benefits under the same benefit category. The requirements do not apply to certain limited benefit policies. Abortion is explicitly excluded from the requirements. Closed formularies (lists of preferred medications) must include oral, implant and injectable contraceptive drugs, intrauterine devices and prescription barrier methods.

Refusal clause.
None.

Hawaii

Year Passed: 1999
Effective Date: January 1, 2000


Requirements. No group health plan may exclude contraceptive services or supplies from coverage. Covered contraceptive services may be provided by a physician, physician assistant, nurse practitioner, certified nurse midwife, or nurse. Covered contraceptive supplies must include at least one brand from the monophasic, multiphasic, and the progestin-only categories; coverage for other oral contraceptives may be had in the event of an adverse drug reaction to covered brands. No plan that provides contraceptive services or supplies or prescription drug coverage may "impose any unusual copayment, charge, or waiting requirement" for contraceptive supplies.

Refusal clause. Any religious employer-and any educational, health care, or other non-profit institution or organization owned or controlled by such an employer-may obtain a plan without contraceptive coverage if it is contrary to its religious tenets. A "religious employer" is an entity (1) whose purpose is the inculcation of religious values; (2) which primarily employs persons who share its religious tenets; (3) which is not staffed by public employees; and (4) which is a nonprofit organization. In order to invoke the refusal clause, the employer must (1) provide written notice to enrollees upon enrollment, listing the contraceptive services it refuses to cover; (2) provide written information regarding "expeditious" access to contraceptive services and supplies; and (3) ensure that enrollees have "prompt access" to this information.

Exceptions to refusal clause. No plan may exclude coverage for prescription contraceptives ordered by a provider for purposes other than contraception, or where necessary to preserve the life or health of an enrollee. Enrollees in a plan exempted under the refusal clause must be allowed to purchase coverage of contraceptives directly, at a cost not to exceed the pro rata share of the price their religious employer would have paid for such coverage.

Illinois

Year Passed: 2003
Effective Date: June 1, 2004


Requirements.
All accident and health plans that cover outpatient services, drugs and devices must also cover outpatient contraceptive services, drugs and devices. Contraceptive services are defined to include consultations, examinations, procedures, and medical services related to the prevention of unintended pregnancy. Abortion and surgical sterilization services are explicitly excluded from the requirements. Coverage must extend to the insured and his or her dependents. Deductibles, coinsurance, waiting periods, or other limitations for contraceptives may not be greater than those which would be required for any other covered service, drug or device.

Refusal clause. Under the state’s Health Care Right of Conscience Act, health care payers are exempt from civil and criminal liability for refusing to cover any health care services—including family planning, counseling, referrals, or any advice in connection with contraceptives, sterilization and abortion—that violate the payer’s "conscience." "Conscience" is defined as a "sincerely held set of moral convictions arising from belief in and relation to God," or "from a place in the life of its possessor parallel to that filled by God among adherents to religious faiths." Those convictions must be documented in the payer’s ethical guidelines, mission statement, constitution, bylaws, articles of incorporation, regulations, or other governing documents.

Exceptions to refusal clause. None.

Iowa

Year Passed: 2000
Effective Date: July 1, 2000


Requirements. A group or individual plan may not exclude prescription contraceptive drugs or devices (or generic equivalents approved as substitutes) if it covers other outpatient prescription drugs or devices. Likewise, a group plan may not exclude or restrict benefits for outpatient contraceptive services if it provides benefits for other outpatient services. An insurer may not deny eligibility to an enrollee based on the enrollee's use or potential use of contraceptives, and may not provide payment to encourage a covered individual to accept less than minimum benefits. Similarly, an insurer may not penalize a health care professional for prescribing contraceptives or providing contraceptive services, and may not provide incentives to induce such a professional to withhold contraceptive prescriptions or services. Deductibles, coinsurance and copayments for contraceptive drugs, devices and services may not be greater than those for other drugs, devices and services. An insurer need not provide benefits for "experimental or investigational" contraceptives except to the extent that it covers other "experimental or investigational" drugs, devices and services. Certain kinds of limited benefit plans are excluded from the requirements.

Refusal clause.
The policyholder of an individual plan has the option of rejecting the coverage of contraceptives, but the law does not exempt religious or other organizations.

Maine

Year Passed: 1999
Effective Date: March 1, 2000


Requirements. All plans that cover prescription drugs or outpatient services must also cover prescription contraceptives or outpatient contraceptive services to the same extent. Prescription drugs and devices "that are designed to terminate a pregnancy" are explicitly excluded.

Refusal clause. A religious employer may obtain a plan that excludes contraceptive coverage if such coverage conflicts with its "bona fide religious beliefs and practices." A "religious employer" is a church, convention or association of churches, or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches, as defined under federal law, and that qualifies as a tax-exempt organization under the IRC. The employer must give individuals insured under its plan written notice of this exclusion.

Exceptions to refusal clause. A nonprofit health care organization or insurer may not exclude coverage for drugs prescribed for purposes other than contraception, or for prescription contraceptives that are necessary to preserve the life or health of a covered individual.

Maryland

Year Passed: 1998
Effective Date: October 1, 1998


Requirements. Insurers and plans that cover prescription drugs must also provide coverage for any prescribed contraceptive drug or device, for the insertion or removal of such a device, and for any medically necessary examination associated with the use of contraceptives.

Refusal clause. A religious organization may obtain a plan which excludes contraceptives from coverage if such coverage conflicts with its "bona fide religious beliefs and practices." The law does not define the term "religious organization." An organization invoking the refusal clause must give its employees "reasonable and timely notice of the exclusion."

Exceptions to refusal clause. None.

Massachusetts ±

Year Passed: 2002
Effective Date: January 1, 2003


Requirements. Any group or individual plan that provides benefits for outpatient services must also provide benefits for outpatient contraceptive services under the same terms and conditions. Likewise, any group or individual plan that provides benefits for outpatient prescription drugs and devices must also provide benefits for outpatient prescription contraceptive drugs or devices under the same terms and conditions. Insurers may, nonetheless, use closed or restricted formularies.

Refusal clause.
An employer that is a church or qualified church-controlled organization, as defined under federal law, is exempt from the requirements.

Exceptions to refusal clause. None.

Missouri ±

Year Passed: 2001
Effective Date: January 1, 2002


Requirements. Each insurer or plan that provides OB/Gyn benefits and pharmaceutical coverage must provide contraceptives either at no charge or at the same level of deductible, coinsurance, or co-payment as any other covered drug. Such insurers must also provide enrollees with direct access to the services of a participating obstetrician/gynecologist of her choice, without imposing additional co-payments, coinsurance or deductibles. Drugs and devices "that are intended to induce an abortion" are explicitly excluded from the definition of "contraceptives," and abortion services are explicitly excluded from the OB/Gyn services that must be covered. Certain supplemental, specialized or short-term plans are not held to the requirements.

Refusal clause. Any person or entity purchasing a plan, or any individual enrollee of a group health plan, may obtain a policy that excludes contraceptive coverage, if the use or provision of contraceptives is contrary to the "moral, ethical or religious beliefs or tenets" of the purchaser or enrollee. Any insurer which is owned, operated or controlled by an entity whose "moral ethical or religious tenets" are contrary to the use or provision of contraceptives need not provide contraceptive coverage.

Exceptions to refusal clause. Except where the insurer itself is exempt from providing contraceptives under the refusal clause, enrollees in a health benefit plan that excludes contraceptive coverage (i.e., because the purchaser of the plan is exempt) must be allowed to purchase a plan that includes contraceptive coverage. Plans must provide written notice on the enrollment materials and the contract as to whether or not contraceptives are covered, and specify the rights of enrollees with regard to opting out of contraceptive coverage or purchasing separate contraceptive coverage. The identity of enrollees purchasing separate coverage, or opting out of coverage, must be kept confidential. Insurers and purchasers are prohibited from discriminating against enrollees based on their decision to purchase separate coverage or to opt out of coverage.

Nevada ±

Year Passed: 1999
Effective Date: October 1, 1999


Requirements.
An insurer that provides coverage for prescription drugs or devices must also provide coverage for any type of drug or device for contraception. Deductibles, copayments or coinsurance, waiting periods, or other conditions on contraceptive benefits may not exceed those required for other covered drugs. Insurers may not: refuse to issue a policy or cancel a policy solely because the applicant or enrollee uses or may use contraceptives; offer any incentive to discourage the insured from accessing contraceptives; offer any incentive to induce a health care provider from denying, limiting or delaying contraceptive access; or penalize a health care provider for providing contraceptives.

Refusal clause. An insurer that is "affiliated with a religious organization" is not required to provide contraceptive coverage "if the insurer objects on religious grounds." Such an insurer must provide advance written notice to prospective enrollees that the insurer refuses to provide contraceptive coverage. Nevada law includes similar provisions governing contracts for hospitals, medical services and HMOs.

Exceptions to refusal clause.
None.

New Hampshire

Year Passed: 1999
Effective Date: January 1, 2000


Requirements. Each insurer providing group or blanket policies covering outpatient services must also provide coverage for outpatient contraceptive services under the same terms and conditions. Likewise, each insurer providing group or blanket policies that include prescription riders must also cover prescriptive contraceptive drugs and devices under the same terms and conditions.

Refusal clause. None.

New Mexico

Year Passed: 2003
Effective Date: June 20, 2003
(Note that a previous version of this law has been in effect since June 19, 2001)


Requirements. All individual and group plans that provide prescription drug benefits must also provide coverage for prescription contraceptive drugs or devices. Deductibles and coinsurance imposed on such contraceptives must be consistent with those imposed on other benefits. Certain limited policies are exempt from the requirements.

Refusal clause. A religious entity may elect to exclude coverage of prescription contraceptive drugs or devices.

Exceptions to refusal clause. None.

New York ±

Year Passed: 2002
Effective Date: January 1, 2003


Requirements. Plans that provide coverage for prescription drugs must also include coverage for contraceptive drugs or devices (and generic equivalents approved as substitutes). In addition, direct access by a female insured to primary and preventive OB/Gyn care may not be limited beyond certain minimum provisions.

Refusal clause. A religious employer may obtain a plan that does not cover contraceptive methods that are "contrary to the religious employer's religious tenets." A "religious employer" is an entity (1) the purpose of which is the inculcation of religious values; (2) which primarily employs persons who share its religious tenets; (3) which serves primarily persons who share its religious tenets; and (4) which is a nonprofit organization. Such an employer must provide advance written notice to prospective enrollees, listing the contraceptive services it refuses to cover.

Exceptions to refusal clause. Enrollees in a plan that does not cover contraceptives may purchase a rider under which contraceptives are covered directly from the insurer, at the "prevailing small group community rate" for such a rider. The insurer must notify, in writing, enrollees whose plan does not cover contraceptives of their right to purchase coverage directly. Drugs prescribed for reasons other than contraceptive purposes may not be excluded from coverage.

North Carolina ±

Year Passed: 1999
Effective Date: January 1, 2000


Requirements. Every insurer that provides coverage for prescription drugs or devices must also provide coverage for prescription contraceptive drugs or devices. Similarly, every insurer that provides coverage for outpatient services must also provide coverage for outpatient contraceptive services. Coverage of contraceptive drugs and devices must include their insertion or removal, and any medically necessary examination associated with their use. Deductibles, coinsurance, and other limitations on contraceptives must be the equivalent of those applied to other covered prescription drugs, but a plan may require advance payment of coinsurance for those contraceptives that do not have to be refilled on a periodic basis. Plans may not: deny eligibility or coverage renewal for the purpose of avoiding the requirements; provide participants with incentives to accept less than the minimum provisions to which they are entitled; penalize providers who provide contraceptive prescriptions or services; or provide providers with incentives to withhold contraceptive prescriptions or services. Plans that are limited in duration or content may be exempt from the requirements. Medical abortion agents (i.e., RU-486 or its equivalent) and emergency contraception (i.e., Preven or its equivalent) are explicitly excluded.

Refusal clause. A religious employer may obtain a plan that does not cover prescription contraceptives that are contrary to its religious tenets. A "religious employer" is an entity (1) which is organized and operated for religious purposes, and which is tax-exempt under the IRC; (2) one of whose primary purposes is the inculcation of religious values; and (3) which employs primarily persons who share its religious tenets.

Exceptions to refusal clause.
A plan may not exclude coverage for drugs prescribed for purposes other than contraception, or for prescription contraceptives necessary to preserve the life or health of a covered individual.

Rhode Island

Year Passed: 2000
Effective Date: January 1, 2001


Requirements. Every plan that provides prescription coverage must also provide coverage of prescription contraceptive drugs and devices. RU-486 is explicitly excluded from the requirements.

Refusal clause. An insurer may issue to a religious employer an individual or group plan that excludes coverage for prescription contraceptives "which are contrary to the religious employer's bona fide religious tenets." A "religious employer" is an employer that is a "church or qualified church-controlled organization" as defined under federal law. In order to invoke the refusal clause, an employer must provide advance written notice to prospective enrollees, listing the contraceptives the employer refuses to cover.

Exceptions to refusal clause. None.

Refusal clause. A plan issued by an entity "associated with a religious organization"-or any provider of medical or health care services under such a plan-need not "offer, recommend, offer advice concerning, pay for, provide, assist in, perform, arrange, or participate in providing or performing a medical or health care service that violates the religious convictions of the organization." Any invocation of the refusal clause must be stated in writing in the documents related to the plan.

Exceptions to refusal clause.
A plan may not refuse to cover prescription contraceptives that are necessary to preserve the life or health of the insured.

Vermont

Year Passed: 1999
Effective Date: July 1, 1999


Requirements. An individual or group health insurance plan must cover outpatient contraceptive services. A plan that covers prescription drugs must also cover all prescription contraceptives and prescription contraceptive devices. The rates, terms and conditions of such coverage may not place a greater financial burden on an insured or beneficiary for access to contraceptives than for access to other treatment, prescriptions and devices.

Refusal clause. None.

Washington

Year Passed: 2001
Effective Date: January 1, 2002


Requirements. An insurer is prohibited from restricting, excluding, or reducing coverage or benefits on the basis of sex. For this reason, a health plan that covers prescription drugs and devices must also cover prescription contraceptives, including medical services associated with the dispensing of contraceptives. Coverage of contraceptives may not be offered on a "less favorable basis" than coverage of other prescription drugs and devices. A plan may not impose waiting periods or other limitations on prescription contraceptive coverage that it does not also impose on the coverage of other drugs and devices. Deductibles and copayments may be imposed on contraceptive coverage to the same extent as they are imposed on other benefits. An insurer may use a closed formulary (a list of preferred medications) for contraceptives if they otherwise use a closed formulary, but it must include each of several enumerated types of prescription contraceptives.

Refusal clause. None.

West Virginia

Year Passed: 2005
Effective Date: July 8, 2005


Requirements.
Health insurance plans that provide benefits for prescription drugs or devices must also cover prescription contraception. Health insurance plans that provide benefits for outpatient health services may not exclude or restrict coverage for outpatient contraceptive services. Health insurance plans are prohibited from imposing deductibles, copayments, or waiting periods on contraceptive benefits that are greater than those that are imposed on other covered drugs, devices, or outpatient services. Insurance plans are also prohibited from penalizing or reducing the reimbursement of a health care professional because he or she provided contraceptive services, or prescribed contraceptive drugs or devices.

Refusal Clause.
A religious employer may exclude or restrict benefits for contraceptive drugs or devices that are contrary to the religious employer's religious tenets. A religious employer is defined as one whose sincere religious beliefs are central to the employer's operating principles and that is either designated under 26 U.S.C. Section 501 (c) (3) or 26 U.S.C 3121, or listed in the Official Catholic Directory published by P.J. Kennedy and Sons.

Exceptions to Refusal Clause. Religious employers may not deny coverage of prescription contraceptives for purposes other than contraception, such as decreasing the risk of ovarian cancer or mitigating symptoms of menopause, or for prescription contraception that is necessary to preserve the life or health of a plan enrolee. Religious employers invoking the exception must provide written notice to enrolees prior to enrollment and must make available a rider that provides prescription contraceptive drugs and devices.

Wisconsin**


Requirements: Although a contraceptive equity law has not been enacted in Wisconsin, an Attorney General opinion issued on August 16, 2004, interpreted the state’s existing law to provide that no health care plan that includes prescription drug coverage may exclude coverage for prescription contraceptives. Wisconsin’s Fair Employment Act prohibits sex discrimination, and thus dictates that coverage of some prescription drugs necessitates equitable access to contraceptive methods for women, regardless of the purpose of such contraceptives.

Refusal Clause: None.


* Texas passed a law in 2001 requiring contraceptive equity, however it passed a further law in 2003 that diluted the contraceptive coverage requirement by allowing insurers to offer plans that do not include state-mandated benefits. Thus Texas no longer has an effective contraception coveraged mandate in place.

** An Attorney General Opinion created a mandate, but no statutory enactment has occurred.