2019 -- H 5815

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LC002033

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Representatives Kazarian, Casimiro, Alzate, Blazejewski, and Fogarty

     Date Introduced: March 07, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

1

     SECTION 1. Section 27-18-57 of the General Laws in Chapter 27-18 entitled "Accident

2

and Sickness Insurance Policies" is hereby amended to read as follows:

3

     27-18-57. F.D.A. approved prescription contraceptive drugs and devices.

4

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

5

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

6

amended or effective in this state on or after January 1, 2020, in this state shall provide coverage

7

for all of the following services and contraceptive methods. F.D.A. approved contraceptive drugs

8

and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to

9

mandate or require coverage for the prescription drug RU 486.

10

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

11

applies to this coverage:

12

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

13

product, the contract must include either the original FDA-approved contraceptive drug, device,

14

or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the

15

same definition as that set forth by the Federal Drug Administration.

16

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

17

available or are deemed medically inadvisable, a group or blanket policy shall provide coverage

18

for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based

19

on the determination of the health care provider, without cost-sharing;

 

1

     (iii) Coverage required by this section must include all over-the-counter contraceptive

2

drugs, devices and products approved by the United States Food and Drug Administration when

3

prescribed by a licensed provider, excluding male condoms; and

4

     (2) Voluntary sterilization procedures;

5

     (3) Patient education and counseling on contraception; and

6

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

7

under this section, including, but not limited to, management of side effects, counseling for

8

continued adherence, and device insertion and removal.

9

     (b) A group or blanket policy subject to this section shall not impose a deductible,

10

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

11

to this section. For a qualifying high-deductible health plan for a health savings account, the

12

carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at

13

the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions

14

and withdrawals from his or her health savings account under 26 U.S.C. § 223.

15

     (c) Except as otherwise authorized under this subsection, a group or blanket policy shall

16

not impose any restrictions or delays on the coverage required under this section.

17

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

18

spouse or domestic partner and covered non-spouse dependents.

19

     (b)(e) Notwithstanding any other provision of this section, any insurance company may

20

issue to a religious employer an individual or group health insurance contract, plan, or policy that

21

excludes coverage for prescription contraceptive methods which are contrary to the religious

22

employer's bona fide religious tenets.

23

     (c)(f) As used in this section, "religious employer" means an employer that is a "church

24

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

25

     (d)(g) This section does not apply to insurance coverage providing benefits for: (1)

26

hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5)

27

Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of

28

bodily injury or death by accident or both; and (9) other limited benefit policies.

29

     (e)(h) Every religious employer that invokes the exemption provided under this section

30

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

31

contraceptive health care services the employer refuses to cover for religious reasons.

32

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

33

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

34

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

 

LC002033 - Page 2 of 11

1

preserve the life or health of an enrollee.

2

     (j) Beginning on the first day of each plan year after April 1, every health insurance

3

issuer offering group or individual health insurance coverage that covers prescription

4

contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive

5

up to three hundred sixty-five (365) days at a time.

6

     27-18-57. F.D.A. approved prescription contraceptive drugs and devices. [Effective

7

April 1, 2019.]

8

     (a) Every individual or group health-insurance contract, plan, or policy issued pursuant to

9

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

10

amended or effective in this state on January 1, 2020 in this state shall provide coverage for

11

F.D.A. approved contraceptive drugs and devices requiring a prescription all of the following

12

services and contraceptive methods. Provided, that nothing in this subsection shall be deemed to

13

mandate or require coverage for the prescription drug RU 486.

14

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

15

applies to this coverage:

16

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

17

product, the contract must include either the original FDA-approved contraceptive drug, device,

18

or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the

19

same definition as that set forth by the Federal Drug Administration.

20

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

21

available or are deemed medically inadvisable, a group or blanket policy shall provide coverage

22

for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based

23

on the determination of the health care provider, without cost-sharing;

24

     (iii) Coverage required by this section must include all over-the-counter contraceptive

25

drugs, devices and products approved by the United States Food and Drug Administration when

26

prescribed by a licensed provider, excluding male condoms; and

27

     (2) Voluntary sterilization procedures;

28

     (3) Patient education and counseling on contraception; and

29

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

30

under this section, including, but not limited to, management of side effects, counseling for

31

continued adherence, and device insertion and removal.

32

     (b) A group or blanket policy subject to this section shall not impose a deductible,

33

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

34

to this section. For a qualifying high-deductible health plan for a health savings account, the

 

LC002033 - Page 3 of 11

1

carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at

2

the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions

3

and withdrawals from his or her health savings account under 26 U.S.C. § 223.

4

     (c) Except as otherwise authorized under this subsection, a group or blanket policy shall

5

not impose any restrictions or delays on the coverage required under this section.

6

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

7

spouse or domestic partner and covered non-spouse dependents.

8

     (b)(e) Notwithstanding any other provision of this section, any insurance company may

9

issue to a religious employer an individual or group health-insurance contract, plan, or policy that

10

excludes coverage for prescription contraceptive methods that are contrary to the religious

11

employer's bona fide religious tenets.

12

     (c)(f) As used in this section, "religious employer" means an employer that is a "church

13

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

14

     (d)(g) This section does not apply to insurance coverage providing benefits for: (1)

15

Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care;

16

(5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8)

17

Sickness or bodily injury or death by accident or both; and (9) Other limited-benefit policies.

18

     (e)(h) Every religious employer that invokes the exemption provided under this section

19

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

20

contraceptive health-care services the employer refuses to cover for religious reasons.

21

     (f)(i) Beginning on the first day of each plan year after April 1, 2019, every health-

22

insurance issuer offering group or individual health-insurance coverage that covers prescription

23

contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive

24

up to three hundred sixty-five (365) days at a time.

25

     (j) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

26

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

27

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

28

preserve the life or health of an enrollee.

29

     (k) Beginning on the first day of each plan year after April 1, every health insurance

30

issuer offering group or individual health insurance coverage that covers prescription

31

contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive

32

up to three hundred sixty-five (365) days at a time.

33

     SECTION 2. Section 27-19-48 of the General Laws in Chapter 27-19 entitled "Nonprofit

34

Hospital Service Corporations" is hereby amended to read as follows:

 

LC002033 - Page 4 of 11

1

     27-19-48. F.D.A. approved prescription contraceptive drugs and devices.

2

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

3

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

4

amended or effective in this state on or after January 1, 2020, in this state shall provide coverage

5

for all of the following services and contraceptive methods. F.D.A. approved contraceptive drugs

6

and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to

7

mandate or require coverage for the prescription drug RU 486.

8

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

9

applies to this coverage:

10

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

11

product, the contract must include either the original FDA-approved contraceptive drug, device,

12

or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the

13

same definition as that set forth by the Federal Drug Administration.

14

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

15

available or are deemed medically inadvisable, a group or blanket policy shall provide coverage

16

for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based

17

on the determination of the health care provider, without cost-sharing;

18

     (iii) Coverage required by this section must include all over-the-counter contraceptive

19

drugs, devices and products approved by the United States Food and Drug Administration when

20

prescribed by a licensed provider, excluding male condoms; and

21

     (2) Voluntary sterilization procedures;

22

     (3) Patient education and counseling on contraception; and

23

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

24

under this section, including, but not limited to, management of side effects, counseling for

25

continued adherence, and device insertion and removal.

26

     (b) A group or blanket policy subject to this section shall not impose a deductible,

27

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

28

to this section. For a qualifying high-deductible health plan for a health savings account, the

29

carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at

30

the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions

31

and withdrawals from his or her health savings account under 26 U.S.C. § 223.

32

     (c) Except as otherwise authorized under this subsection, a group or blanket policy shall

33

not impose any restrictions or delays on the coverage required under this section.

34

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

 

LC002033 - Page 5 of 11

1

spouse or domestic partner and covered non-spouse dependents.

2

     (b)(e) Notwithstanding any other provision of this section, any insurance company may

3

issue to a religious employer an individual or group health insurance contract, plan, or policy that

4

excludes coverage for prescription contraceptive methods which are contrary to the religious

5

employer's bona fide religious tenets.

6

     (c)(f) As used in this section, "religious employer" means an employer that is a "church

7

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

8

     (d)(g) This section does not apply to insurance coverage providing benefits for: (1)

9

hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5)

10

Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of

11

bodily injury or death by accident or both; and (9) other limited benefit policies.

12

     (e)(h) Every religious employer that invokes the exemption provided under this section

13

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

14

contraceptive health care services the employer refuses to cover for religious reasons.

15

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

16

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

17

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

18

preserve the life or health of an enrollee.

19

     (j) Beginning on the first day of each plan year after April 1, every health insurance

20

issuer offering group or individual health insurance coverage that covers prescription

21

contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive

22

up to three hundred sixty-five (365) days at a time.

23

     SECTION 3. Section 27-20-43 of the General Laws in Chapter 27-20 entitled "Nonprofit

24

Medical Service Corporations" is hereby amended to read as follows:

25

     27-20-43. F.D.A. approved prescription contraceptive drugs and devices.

26

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

27

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

28

amended or effective in this state on or after January 1, 2020, in this state shall provide coverage

29

for all of the following services and contraceptive methods. F.D.A. approved contraceptive drugs

30

and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to

31

mandate or require coverage for the prescription drug RU 486.

32

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

33

applies to this coverage:

34

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

 

LC002033 - Page 6 of 11

1

product, the contract must include either the original FDA-approved contraceptive drug, device,

2

or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the

3

same definition as that set forth by the Federal Drug Administration.

4

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

5

available or are deemed medically inadvisable, a group or blanket policy shall provide coverage

6

for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based

7

on the determination of the health care provider, without cost-sharing;

8

     (iii) Coverage required by this section must include all over-the-counter contraceptive

9

drugs, devices and products approved by the United States Food and Drug Administration when

10

prescribed by a licensed provider, excluding male condoms; and

11

     (2) Voluntary sterilization procedures;

12

     (3) Patient education and counseling on contraception; and

13

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

14

under this section, including, but not limited to, management of side effects, counseling for

15

continued adherence, and device insertion and removal.

16

     (b) A group or blanket policy subject to this section shall not impose a deductible,

17

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

18

to this section. For a qualifying high-deductible health plan for a health savings account, the

19

carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at

20

the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions

21

and withdrawals from his or her health savings account under 26 U.S.C. § 223.

22

     (c) Except as otherwise authorized under this subsection, a group or blanket policy shall

23

not impose any restrictions or delays on the coverage required under this section.

24

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

25

spouse or domestic partner and covered non-spouse dependents.

26

     (b)(e) Notwithstanding any other provision of this section, any insurance company may

27

issue to a religious employer an individual or group health insurance contract, plan, or policy that

28

excludes coverage for prescription contraceptive methods which are contrary to the religious

29

employer's bona fide religious tenets.

30

     (c)(f) As used in this section, "religious employer" means an employer that is a "church

31

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

32

     (d)(g) This section does not apply to insurance coverage providing benefits for: (1)

33

hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5)

34

Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of

 

LC002033 - Page 7 of 11

1

bodily injury or death by accident or both; and (9) other limited benefit policies.

2

     (e)(h) Every religious employer that invokes the exemption provided under this section

3

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

4

contraceptive health care services the employer refuses to cover for religious reasons.

5

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

6

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

7

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

8

preserve the life or health of an enrollee.

9

     (j) Beginning on the first day of each plan year after April 1, every health insurance

10

issuer offering group or individual health insurance coverage that covers prescription

11

contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive

12

up to three hundred sixty-five (365) days at a time.

13

     SECTION 4. Section 27-41-59 of the General Laws in Chapter 27-41 entitled "Health

14

Maintenance Organizations" is hereby amended to read as follows:

15

     27-41-59. F.D.A. approved prescription contraceptive drugs and devices.

16

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

17

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

18

amended or effective in this state on or after January 1, 2020, in this state shall provide coverage

19

for all of the following services and contraceptive methods. F.D.A. approved contraceptive drugs

20

and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to

21

mandate or require coverage for the prescription drug RU 486.

22

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

23

applies to this coverage:

24

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

25

product, the contract must include either the original FDA-approved contraceptive drug, device,

26

or product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the

27

same definition as that set forth by the Federal Drug Administration.

28

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

29

available or are deemed medically inadvisable, a group or blanket policy shall provide coverage

30

for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based

31

on the determination of the health care provider, without cost-sharing;

32

     (iii) Coverage required by this section must include all over-the-counter contraceptive

33

drugs, devices and products approved by the United States Food and Drug Administration when

34

prescribed by a licensed provider, excluding male condoms; and

 

LC002033 - Page 8 of 11

1

     (2) Voluntary sterilization procedures;

2

     (3) Patient education and counseling on contraception; and

3

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

4

under this section, including, but not limited to, management of side effects, counseling for

5

continued adherence, and device insertion and removal.

6

     (b) A group or blanket policy subject to this section shall not impose a deductible,

7

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

8

to this section. For a qualifying high-deductible health plan for a health savings account, the

9

carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at

10

the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions

11

and withdrawals from his or her health savings account under 26 U.S.C. § 223.

12

     (c) Except as otherwise authorized under this subsection, a group or blanket policy shall

13

not impose any restrictions or delays on the coverage required under this section.

14

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

15

spouse or domestic partner and covered non-spouse dependents.

16

     (b)(e) Notwithstanding any other provision of this section, any insurance company may

17

issue to a religious employer an individual or group health insurance contract, plan, or policy that

18

excludes coverage for prescription contraceptive methods which are contrary to the religious

19

employer's bona fide religious tenets.

20

     (c)(f) As used in this section, "religious employer" means an employer that is a "church

21

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

22

     (d)(g) This section does not apply to insurance coverage providing benefits for: (1)

23

hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5)

24

Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of

25

bodily injury or death by accident or both; and (9) other limited benefit policies.

26

     (e)(h) Every religious employer that invokes the exemption provided under this section

27

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

28

contraceptive health care services the employer refuses to cover for religious reasons.

29

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

30

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

31

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

32

preserve the life or health of an enrollee.

33

     (j) Beginning on the first day of each plan year after April 1, every health insurance

34

issuer offering group or individual health insurance coverage that covers prescription

 

LC002033 - Page 9 of 11

1

contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive

2

up to three hundred sixty-five (365) days at a time.

3

     SECTION 5. This act shall take effect upon passage.

========

LC002033

========

 

LC002033 - Page 10 of 11

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

1

     This act would require every individual or group health insurance contract effective on or

2

after January 1, 2020, to provide coverage to the insured and the insured's spouse and dependents

3

for all FDA-approved contraceptive drugs, devices and other products, voluntary sterilization

4

procedures, patient education and counseling on contraception and follow-up services.

5

     This act would take effect upon passage.

========

LC002033

========

 

LC002033 - Page 11 of 11