S T A T E O F N E W Y O R K
________________________________________________________________________
9120
I N S E N A T E
June 20, 2018
___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
AN ACT to amend the insurance law, in relation to requiring health
insurance policies to include coverage of all FDA-approved contracep-
tive drugs, devices, and products, contraceptive education and coun-
seling, and related follow up services and prohibiting a health insur-
ance 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:
Section 1. Paragraph 16 of subsection (l) of section 3221 of the
insurance law, as added by chapter 554 of the laws of 2002, is amended
to read as follows:
(16) (A) Every group or blanket policy which provides coverage for
prescription drugs shall [include coverage for the cost of contraceptive
drugs or devices approved by the federal food and drug administration or
generic equivalents approved as substitutes by such food and drug admin-
istration under the prescription of a health care provider legally
authorized to prescribe under title eight of the education law. The
coverage required by this section shall be included in policies and
certificates only through the addition of a rider.
(A)] PROVIDE COVERAGE FOR ALL OF THE FOLLOWING SERVICES AND CONTRACEP-
TIVE METHODS:
(1) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER PRODUCTS
PROVIDED FOR IN COMPREHENSIVE GUIDELINES SUPPORTED BY THE HEALTH
RESOURCES AND SERVICES ADMINISTRATION (HRSA), AS PRESCRIBED BY A PHYSI-
CIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW. THE FOLLOWING APPLIES
TO THIS COVERAGE:
(A) WHERE THE FDA HAS APPROVED ONE OR MORE FORMS OF CONTRACEPTION
WITHIN A METHOD OF CONTRACEPTION IDENTIFIED BY THE FDA, A GROUP OR BLAN-
KET POLICY IS NOT REQUIRED TO INCLUDE ALL SUCH FORMS IN ITS FORMULARY,
SO LONG AS AT LEAST ONE IS INCLUDED AND COVERED WITHOUT COST-SHARING;
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06579-19-8
S. 9120 2
(B) IF THE TREATING PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER
LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW
RECOMMENDS A PARTICULAR SERVICE OR FDA-APPROVED ITEM BASED ON A DETERMI-
NATION OF MEDICAL NECESSITY WITH RESPECT TO THAT INDIVIDUAL, A GROUP OR
BLANKET POLICY MUST COVER THAT SERVICE OR ITEM WITHOUT COST-SHARING;
(C) THIS COVERAGE MUST ALLOW FOR THE DISPENSING OF AN INITIAL THREE-
MONTH SUPPLY. FOR SUBSEQUENT DISPENSING OF THE SAME CONTRACEPTIVE
PRESCRIBED BY THE PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER
LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW
AND COVERED UNDER THE SAME POLICY OR RENEWAL THEREOF, AN INSURER SHALL
ALLOW COVERAGE FOR THE DISPENSING OF THE ENTIRE PRESCRIBED SUPPLY, UP TO
TWELVE MONTHS, AT THE SAME TIME;
(2) PATIENT EDUCATION AND COUNSELING ON CONTRACEPTION WITHOUT COST-
SHARING; AND
(3) FOLLOW-UP SERVICES RELATED TO THE DRUGS, DEVICES, PRODUCTS, AND
PROCEDURES COVERED UNDER THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED TO,
MANAGEMENT OF SIDE EFFECTS, COUNSELING FOR CONTINUED ADHERENCE, AND
DEVICE INSERTION AND REMOVAL WITHOUT COST-SHARING.
(B) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT REASONABLE
MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF DRUGS, DEVICES, PRODUCTS OR
SERVICES PROVIDED HEREIN.
(C) Notwithstanding any other provision of this subsection, a reli-
gious employer may request a contract without coverage for federal food
and drug administration approved contraceptive methods that are contrary
to the religious employer's religious tenets. If so requested, such
contract shall be provided without coverage for contraceptive methods.
This paragraph shall not be construed to deny an enrollee coverage of,
and timely access to, contraceptive methods.
(1) For purposes of this subsection, a "religious employer" is an
entity for which each of the following is true:
(a) The inculcation of religious values is the purpose of the entity.
(b) The entity primarily employs persons who share the religious
tenets of the entity.
(c) The entity serves primarily persons who share the religious tenets
of the entity.
(d) The entity is a nonprofit organization as described in Section
6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
(2) Every religious employer that invokes the exemption provided under
this paragraph shall provide written notice to prospective enrollees
prior to enrollment with the plan, listing the contraceptive health care
services the employer refuses to cover for religious reasons.
[(B) (i)] (D) (1) Where a group policyholder makes an election not to
purchase coverage for contraceptive drugs or devices in accordance with
subparagraph [(A)] (C) of this paragraph each certificateholder covered
under the policy issued to that group policyholder shall have the right
to directly purchase the rider required by this paragraph from the
insurer which issued the group policy at the prevailing small group
community rate for such rider whether or not the employee is part of a
small group.
[(ii)] (2) Where a group policyholder makes an election not to
purchase coverage for contraceptive drugs or devices in accordance with
subparagraph [(A)] (C) of this paragraph, the insurer that provides such
coverage shall provide written notice to certificateholders upon enroll-
ment with the insurer of their right to directly purchase a rider for
coverage for the cost of contraceptive drugs or devices. The notice
S. 9120 3
shall also advise the certificateholders of the additional premium for
such coverage.
[(C)] (E) Nothing in this paragraph shall be construed as authorizing
a group or blanket policy which provides coverage for prescription drugs
to exclude coverage for prescription drugs prescribed for reasons other
than contraceptive purposes.
[(D) Such coverage may be subject to reasonable annual deductibles and
coinsurance as may be deemed appropriate by the superintendent and as
are consistent with those established for other drugs or devices covered
under the policy.]
§ 2. Subsection (cc) of section 4303 of the insurance law, as added by
chapter 554 of the laws of 2002, is amended to read as follows:
(cc) (1) Every contract which provides coverage for prescription drugs
shall [include coverage for the cost of contraceptive drugs or devices
approved by the federal food and drug administration or generic equiv-
alents approved as substitutes by such food and drug administration
under the prescription of a health care provider legally authorized to
prescribe under title eight of the education law. The coverage required
by this section shall be included in contracts and certificates only
through the addition of a rider.
(1)] PROVIDE COVERAGE FOR ALL OF THE FOLLOWING SERVICES AND CONTRACEP-
TIVE METHODS:
(A) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER PRODUCTS
PROVIDED FOR IN COMPREHENSIVE GUIDELINES SUPPORTED BY THE HEALTH
RESOURCES AND SERVICES ADMINISTRATION (HRSA), AS PRESCRIBED BY A PHYSI-
CIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW. THE FOLLOWING APPLIES
TO THIS COVERAGE:
(I) WHERE THE FDA HAS APPROVED ONE OR MORE FORMS OF CONTRACEPTION
WITHIN A METHOD OF CONTRACEPTION IDENTIFIED BY THE FDA, A CONTRACT IS
NOT REQUIRED TO INCLUDE ALL SUCH FORMS IN ITS FORMULARY, SO LONG AS AT
LEAST ONE IS INCLUDED AND COVERED WITHOUT COST-SHARING;
(II) IF THE TREATING PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER
LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW
RECOMMENDS A PARTICULAR SERVICE OR FDA-APPROVED ITEM BASED ON A DETERMI-
NATION OF MEDICAL NECESSITY WITH RESPECT TO THAT INDIVIDUAL, A CONTRACT
MUST COVER THAT SERVICE OR ITEM WITHOUT COST-SHARING;
(III) THIS COVERAGE MUST ALLOW FOR THE DISPENSING OF AN INITIAL THREE-
MONTH SUPPLY. FOR SUBSEQUENT DISPENSING OF THE SAME CONTRACEPTIVE
PRESCRIBED BY THE PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER
LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW
AND COVERED UNDER THE SAME POLICY OR RENEWAL THEREOF, AN INSURER SHALL
ALLOW COVERAGE FOR THE DISPENSING OF THE ENTIRE PRESCRIBED SUPPLY, UP TO
TWELVE MONTHS, AT THE SAME TIME;
(B) PATIENT EDUCATION AND COUNSELING ON CONTRACEPTION WITHOUT COST-
SHARING; AND
(C) FOLLOW-UP SERVICES RELATED TO THE DRUGS, DEVICES, PRODUCTS, AND
PROCEDURES COVERED UNDER THIS SUBSECTION, INCLUDING, BUT NOT LIMITED TO,
MANAGEMENT OF SIDE EFFECTS, COUNSELING FOR CONTINUED ADHERENCE, AND
DEVICE INSERTION AND REMOVAL WITHOUT COST-SHARING.
(2) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT REASONABLE
MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF DRUGS, DEVICES, PRODUCTS OR
SERVICES PROVIDED HEREIN.
(3) Notwithstanding any other provision of this subsection, a reli-
gious employer may request a contract without coverage for federal food
and drug administration approved contraceptive methods that are contrary
S. 9120 4
to the religious employer's religious tenets. If so requested, such
contract shall be provided without coverage for contraceptive methods.
This paragraph shall not be construed to deny an enrollee coverage of,
and timely access to, contraceptive methods.
(A) For purposes of this subsection, a "religious employer" is an
entity for which each of the following is true:
(i) The inculcation of religious values is the purpose of the entity.
(ii) The entity primarily employs persons who share the religious
tenets of the entity.
(iii) The entity serves primarily persons who share the religious
tenets of the entity.
(iv) The entity is a nonprofit organization as described in Section
6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
(B) Every religious employer that invokes the exemption provided under
this paragraph shall provide written notice to prospective enrollees
prior to enrollment with the plan, listing the contraceptive health care
services the employer refuses to cover for religious reasons.
[(2)](4) (A) Where a group contractholder makes an election not to
purchase coverage for contraceptive drugs or devices in accordance with
paragraph [one] THREE of this subsection, each enrollee covered under
the contract issued to that group contractholder shall have the right to
directly purchase the rider required by this subsection from the insurer
or health maintenance organization which issued the group contract at
the prevailing small group community rate for such rider whether or not
the employee is part of a small group.
(B) Where a group contractholder makes an election not to purchase
coverage for contraceptive drugs or devices in accordance with paragraph
[one] THREE of this subsection, the insurer or health maintenance organ-
ization that provides such coverage shall provide written notice to
enrollees upon enrollment with the insurer or health maintenance organ-
ization of their right to directly purchase a rider for coverage for the
cost of contraceptive drugs or devices. The notice shall also advise the
enrollees of the additional premium for such coverage.
[(3)](5) Nothing in this subsection shall be construed as authorizing
a contract which provides coverage for prescription drugs to exclude
coverage for prescription drugs prescribed for reasons other than
contraceptive purposes.
[(4) Such coverage may be subject to reasonable annual deductibles and
coinsurance as may be deemed appropriate by the superintendent and as
are consistent with those established for other drugs or devices covered
under the policy.]
§ 3. Clauses (iii) and (iv) of subparagraph (E) of paragraph 17 of
subsection (i) of section 3216 of the insurance law, as amended by chap-
ter 219 of the laws of 2011, are amended and a new clause (v) is added
to read as follows:
(iii) with respect to children, including infants and adolescents,
evidence-informed preventive care and screenings provided for in compre-
hensive guidelines supported by the health resources and services admin-
istration; [and]
(iv) with respect to women, such additional preventive care and
screenings not described in item (i) of this subparagraph and as
provided for in comprehensive guidelines supported by the health
resources and services administration[.]; AND
(V) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER PRODUCTS
PROVIDED FOR IN COMPREHENSIVE GUIDELINES SUPPORTED BY THE HEALTH
RESOURCES AND SERVICES ADMINISTRATION (HRSA), AS PRESCRIBED BY A PHYSI-
S. 9120 5
CIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW; PATIENT EDUCATION AND
COUNSELING ON CONTRACEPTION; AND FOLLOW-UP SERVICES RELATED TO THE
DRUGS, DEVICES, PRODUCTS, AND PROCEDURES COVERED UNDER THIS CLAUSE,
INCLUDING, BUT NOT LIMITED TO, MANAGEMENT OF SIDE EFFECTS, COUNSELING
FOR CONTINUED ADHERENCE, AND DEVICE INSERTION AND REMOVAL. HOWEVER,
WHERE THE FDA HAS APPROVED ONE OR MORE FORMS OF CONTRACEPTION WITHIN A
METHOD OF CONTRACEPTION IDENTIFIED BY THE FDA, VERSIONS OF A CONTRACEP-
TIVE DRUG, DEVICE, OR PRODUCT, A CONTRACT IS NOT REQUIRED TO INCLUDE ALL
SUCH METHODS IN ITS FORMULARY, SO LONG AS AT LEAST ONE IS INCLUDED AND
COVERED WITHOUT COST-SHARING. PROVIDED, HOWEVER, IF THE TREATING PHYSI-
CIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW RECOMMENDS A PARTICULAR
SERVICE OR FDA-APPROVED ITEM BASED ON THE DETERMINATION OF MEDICAL
NECESSITY WITH RESPECT TO THAT INDIVIDUAL, A CONTRACT MUST COVER THAT
SERVICE OR ITEM WITHOUT COST-SHARING. THIS COVERAGE MUST ALLOW FOR THE
DISPENSING OF AN INITIAL THREE-MONTH SUPPLY. FOR SUBSEQUENT DISPENSING
OF THE SAME CONTRACEPTIVE PRESCRIBED BY THE PHYSICIAN OR OTHER LICENSED
HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT
OF THE EDUCATION LAW AND COVERED UNDER THE SAME POLICY OR RENEWAL THERE-
OF, AN INSURER SHALL ALLOW COVERAGE FOR THE DISPENSING OF THE ENTIRE
PRESCRIBED SUPPLY, UP TO TWELVE MONTHS, AT THE SAME TIME. NOTHING IN
THIS SUBPARAGRAPH SHALL BE CONSTRUED TO PREVENT REASONABLE MEDICAL
MANAGEMENT OR UTILIZATION REVIEW OF DRUGS, DEVICES, PRODUCTS OR SERVICES
PROVIDED HEREIN.
§ 4. This act shall take effect January 1, 2019, and shall apply to
contracts and policies issued, renewed, modified or amended on or after
such date.