2019 -- S 0454 | |
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LC001748 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2019 | |
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A N A C T | |
RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES | |
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Introduced By: Senators Euer, Goldin, Lynch Prata, Murray, and Valverde | |
Date Introduced: February 27, 2019 | |
Referred To: Senate Judiciary | |
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. FDA-approved prescription contraceptive drugs and devices. [Effective |
4 | April 1, 2019.] |
5 | (a) Every individual or group health-insurance contract, plan, or policy issued pursuant to |
6 | this title that provides prescription coverage and is delivered, issued for delivery, or renewed, |
7 | amended or effective in this state on or after January 1, 2020 shall provide coverage for F.D.A. |
8 | approved contraceptive drugs and devices requiring a prescription all of the following services |
9 | and contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate |
10 | or require coverage for the prescription drug RU 486. |
11 | (1) All FDA-approved contraceptive drugs, devices, and other products. The following |
12 | applies to this coverage: |
13 | (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or |
14 | product, the contract must include either the original FDA-approved contraceptive drug device, or |
15 | product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same |
16 | definition as that set forth by the FDA. |
17 | (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not |
18 | available or are deemed medically inadvisable, a group or blanket policy shall provide coverage |
19 | for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based |
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1 | on the determination of the health care provider, without cost-sharing; |
2 | (iii) Coverage required by this section must include all over-the-counter contraceptive |
3 | drugs, devices and products approved by the FDA when prescribed by a licensed provider, |
4 | excluding male condoms; |
5 | (2) Voluntary sterilization procedures. |
6 | (3) Patient education and counseling on contraception; and |
7 | (4) Follow-up services related to the drugs, devices, products, and procedures covered |
8 | under this section, including, but not limited to, management of side effects, counseling for |
9 | continued adherence, and device insertion and removal. |
10 | (b) A group or blanket policy subject to this section shall not impose a deductible, |
11 | coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant |
12 | to this section. For a qualifying high-deductible health plan for a health savings account, the |
13 | carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at |
14 | the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions |
15 | and withdrawals from his or her health savings account under 26 U.S.C. § 223. |
16 | (c) Except as otherwise authorized under this subsection, a group or blanket policy shall |
17 | not impose any restrictions or delays on the coverage required under this section. |
18 | (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered |
19 | spouse or domestic partner and covered non-spouse dependents. |
20 | (b)(e) Notwithstanding any other provision of this section, any insurance company may |
21 | issue to a religious employer an individual or group health-insurance contract, plan, or policy that |
22 | excludes coverage for prescription contraceptive methods that are contrary to the religious |
23 | employer's bona fide religious tenets. |
24 | (c)(f) As used in this section, "religious employer" means an employer that is a "church |
25 | or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121. |
26 | (d)(g) This section does not apply to insurance coverage providing benefits for: (1) |
27 | Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; |
28 | (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) |
29 | Sickness or bodily injury or death by accident or both; and (9) Other limited-benefit policies. |
30 | (e)(h) Every religious employer that invokes the exemption provided under this section |
31 | shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the |
32 | contraceptive health-care services the employer refuses to cover for religious reasons. |
33 | (f)(i) Beginning on the first day of each plan year after April 1, 2019, every health- |
34 | insurance issuer offering group or individual health-insurance coverage that covers prescription |
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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 | (j) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, |
4 | devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of |
5 | ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to |
6 | preserve the life or health of an enrollee. |
7 | SECTION 2. Section 27-19-48 of the General Laws in Chapter 27-19 entitled "Nonprofit |
8 | Hospital Service Corporations" is hereby amended to read as follows: |
9 | 27-19-48. FDA-approved prescription contraceptive drugs and devices. [Effective |
10 | April 1, 2019.] |
11 | (a) Every individual or group health-insurance contract, plan, or policy issued pursuant to |
12 | this title that provides prescription coverage and is delivered, issued for delivery, or renewed, |
13 | amended or effective in this state on or after January 1, 2020 shall provide coverage for F.D.A. |
14 | approved contraceptive drugs and devices requiring a prescription all of the following services |
15 | and contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate |
16 | or require coverage for the prescription drug RU 486. |
17 | (1) All FDA-approved contraceptive drugs, devices, and other products. The following |
18 | applies to this coverage: |
19 | (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or |
20 | product, the contract must include either the original FDA-approved contraceptive drug device, or |
21 | product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same |
22 | definition as that set forth by the FDA. |
23 | (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not |
24 | available or are deemed medically inadvisable, a group or blanket policy shall provide coverage |
25 | for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based |
26 | on the determination of the health care provider, without cost-sharing; |
27 | (iii) Coverage required by this section must include all over-the-counter contraceptive |
28 | drugs, devices and products approved by the FDA when prescribed by a licensed provider, |
29 | excluding male condoms; |
30 | (2) Voluntary sterilization procedures. |
31 | (3) Patient education and counseling on contraception; and |
32 | (4) Follow-up services related to the drugs, devices, products, and procedures covered |
33 | under this section, including, but not limited to, management of side effects, counseling for |
34 | continued adherence, and device insertion and removal. |
| LC001748 - Page 3 of 9 |
1 | (b) A group or blanket policy subject to this section shall not impose a deductible, |
2 | coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant |
3 | to this section. For a qualifying high-deductible health plan for a health savings account, the |
4 | carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at |
5 | the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions |
6 | and withdrawals from his or her health savings account under 26 U.S.C. § 223. |
7 | (c) Except as otherwise authorized under this subsection, a group or blanket policy shall |
8 | not impose any restrictions or delays on the coverage required under this section. |
9 | (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered |
10 | spouse or domestic partner and covered non-spouse dependents. |
11 | (b)(e) Notwithstanding any other provision of this section, any hospital service |
12 | corporation may issue to a religious employer an individual or group health-insurance contract, |
13 | plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to |
14 | the religious employer's bona fide religious tenets. |
15 | (c)(f) As used in this section, "religious employer" means an employer that is a "church |
16 | or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121. |
17 | (d)(g) Every religious employer that invokes the exemption provided under this section |
18 | shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the |
19 | contraceptive health-care services the employer refuses to cover for religious reasons. |
20 | (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health- |
21 | insurance issuer offering group or individual health-insurance coverage that covers prescription |
22 | contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive |
23 | up to three hundred sixty-five (365) days at a time. |
24 | (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, |
25 | devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of |
26 | ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to |
27 | preserve the life or health of an enrollee. |
28 | SECTION 3. Section 27-20-43 of the General Laws in Chapter 27-20 entitled "Nonprofit |
29 | Medical Service Corporations" is hereby amended to read as follows: |
30 | 27-20-43. FDA-approved prescription contraceptive drugs and devices. [Effective |
31 | April 1, 2019.] |
32 | (a) Every individual or group health-insurance contract, plan, or policy issued pursuant to |
33 | this title that provides prescription coverage and is delivered, issued for delivery, or renewed, |
34 | amended or effective in this state on or after January 1, 2020 shall provide coverage for F.D.A. |
| LC001748 - Page 4 of 9 |
1 | approved contraceptive drugs and devices requiring a prescription all of the following services |
2 | and contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate |
3 | or require coverage for the prescription drug RU 486. |
4 | (1) All FDA-approved contraceptive drugs, devices, and other products. The following |
5 | applies to this coverage: |
6 | (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or |
7 | product, the contract must include either the original FDA-approved contraceptive drug device, or |
8 | product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same |
9 | definition as that set forth by the FDA. |
10 | (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not |
11 | available or are deemed medically inadvisable, a group or blanket policy shall provide coverage |
12 | for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based |
13 | on the determination of the health care provider, without cost-sharing; |
14 | (iii) Coverage required by this section must include all over-the-counter contraceptive |
15 | drugs, devices and products approved by the FDA when prescribed by a licensed provider, |
16 | excluding male condoms; |
17 | (2) Voluntary sterilization procedures. |
18 | (3) Patient education and counseling on contraception; and |
19 | (4) Follow-up services related to the drugs, devices, products, and procedures covered |
20 | under this section, including, but not limited to, management of side effects, counseling for |
21 | continued adherence, and device insertion and removal. |
22 | (b) A group or blanket policy subject to this section shall not impose a deductible, |
23 | coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant |
24 | to this section. For a qualifying high-deductible health plan for a health savings account, the |
25 | carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at |
26 | the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions |
27 | and withdrawals from his or her health savings account under 26 U.S.C. § 223. |
28 | (c) Except as otherwise authorized under this subsection, a group or blanket policy shall |
29 | not impose any restrictions or delays on the coverage required under this section. |
30 | (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered |
31 | spouse or domestic partner and covered non-spouse dependents. |
32 | (b)(e) Notwithstanding any other provision of this section, any medical service |
33 | corporation may issue to a religious employer an individual or group health-insurance contract, |
34 | plan, or policy that excludes coverage for prescription contraceptive methods which are contrary |
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1 | to the religious employer's bona fide religious tenets. |
2 | (c)(f) As used in this section, "religious employer" means an employer that is a "church |
3 | or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121. |
4 | (d)(g) Every religious employer that invokes the exemption provided under this section |
5 | shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the |
6 | contraceptive health-care services the employer refuses to cover for religious reasons. |
7 | (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health- |
8 | insurance issuer offering group or individual health-insurance coverage that covers prescription |
9 | contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive |
10 | up to three hundred sixty-five (365) days at a time. |
11 | (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, |
12 | devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of |
13 | ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to |
14 | preserve the life or health of an enrollee. |
15 | SECTION 4. Chapter 42-12.3 of the General Laws entitled "Health Care for Children and |
16 | Pregnant Women" is hereby amended by adding thereto the following section: |
17 | 42-12.3-17. FDA-approved prescription contraceptive drugs and devices. |
18 | (a) Every individual or group health insurance contract, plan, or policy issued pursuant to |
19 | this chapter that is delivered, issued for delivery, renewed, amended or effective in this state on or |
20 | after January 1, 2020 shall provide coverage for all of the following services and contraceptive |
21 | methods. Provided, that nothing in this subsection shall be deemed to mandate or require |
22 | coverage for the prescription drug RU 486. |
23 | (1) All FDA-approved contraceptive drugs, devices, and other products. The following |
24 | applies to this coverage: |
25 | (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or |
26 | product, the contract must include either the original FDA-approved contraceptive drug device, or |
27 | product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same |
28 | definition as that set forth by the FDA. |
29 | (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not |
30 | available or are deemed medically inadvisable, a group or blanket policy shall provide coverage |
31 | for an alternate therapeutic equivalent version of the contraceptive drug, device, or product, based |
32 | on the determination of the health care provider, without cost-sharing; |
33 | (iii) Coverage required by this section must include all over-the-counter contraceptive |
34 | drugs, devices and products approved by the FDA when prescribed by a licensed provider, |
| LC001748 - Page 6 of 9 |
1 | excluding male condoms; |
2 | (2) Voluntary sterilization procedures. |
3 | (3) Patient education and counseling on contraception; and |
4 | (4) Follow-up services related to the drugs, devices, products, and procedures covered |
5 | under this section, including, but not limited to, management of side effects, counseling for |
6 | continued adherence, and device insertion and removal. |
7 | (b) A group or blanket policy subject to this section shall not impose a deductible, |
8 | coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant |
9 | to this section. For a qualifying high-deductible health plan for a health savings account, the |
10 | carrier shall establish the plan's cost-sharing for the coverage provided pursuant to this section at |
11 | the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions |
12 | and withdrawals from his or her health savings account under 26 U.S.C. § 223. |
13 | (c) Except as otherwise authorized under this subsection, a group or blanket policy shall |
14 | not impose any restrictions or delays on the coverage required under this section. |
15 | (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered |
16 | spouse or domestic partner and covered non-spouse dependents. |
17 | (e) Notwithstanding any other provision of this section, any health maintenance |
18 | corporation may issue to a religious employer an individual or group health insurance contract, |
19 | plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to |
20 | the religious employer's bona fide religious tenets. |
21 | (f) As used in this section, "religious employer" means an employer that is a "church or a |
22 | qualified church-controlled organization" as defined in 26 U.S.C. § 3121. |
23 | (g) Every religious employer that invokes the exemption provided under this section shall |
24 | provide written notice to prospective enrollees prior to enrollment with the plan, listing the |
25 | contraceptive health care services the employer refuses to cover for religious reasons. |
26 | (h) Beginning on the first day of each plan year after April 1, 2019, every health |
27 | insurance issuer offering group or individual health insurance coverage that covers prescription |
28 | contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive |
29 | up to three hundred sixty-five (365) days at a time. |
30 | (j) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, |
31 | devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of |
32 | ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to |
33 | preserve the life or health of an enrollee. |
34 | SECTION 5. This act shall take effect upon passage. |
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LC001748 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES | |
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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 as well as |
5 | Medicaid coverage for a twelve (12) month supply for Medicaid recipients. |
6 | This act would take effect upon passage. |
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LC001748 | |
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