REPORT TITLE:
Contraceptive Services


DESCRIPTION:
Requires all health insurers, mutual benefit societies, and
health maintenance organizations to cease excluding contraceptive
services and supplies from coverage by repealing the provision of
such coverage as an employer option; exempts certain employers
from providing coverage for contraceptive health care services
and supplies that are contrary to the employer's religious
tenets. (SB822 HD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        822
THE SENATE                              S.B. NO.           S.D. 2
TWENTIETH LEGISLATURE, 1999                                H.D. 1
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH INSURANCE.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  Chapter 431, Hawaii Revised Statutes, is amended
 
 2 by adding a new section to article 10A to be appropriately
 
 3 designated and to read as follows:
 
 4      "�431:10A-     Contraceptive services; religious employers
 
 5 exemption.  (a)  A "religious employer" is an entity for which
 
 6 each of the following is true:
 
 7      (1)  The inculcation of religious values is the purpose of
 
 8           the entity;
 
 9      (2)  The entity primarily employs persons who share the
 
10           religious tenets of the entity; and
 
11      (3)  The entity is a nonprofit organization as defined under
 
12           section 501(c)(3) of the Internal Revenue Code of 1986,
 
13           as amended.
 
14      (b)  Notwithstanding any other provision of this chapter,
 
15 any religious employer may request a health insurance plan that
 
16 excludes coverage for contraceptive health care services and
 
17 contraceptive supplies that are contrary to the religious
 
18 employer's religious tenets.  If so requested, the health
 

 
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 1 insurer, mutual benefit society, or health maintenance
 
 2 organization shall provide a health insurance plan that excludes
 
 3 coverage for contraceptive health care services and contraceptive
 
 4 supplies.  This subsection shall not be construed to deny an
 
 5 enrollee coverage of, and timely access to, prescription
 
 6 contraceptive drugs and devices and outpatient contraceptive
 
 7 services.
 
 8      (c)  Each religious employer that invokes the exemption
 
 9 provided under this section shall:
 
10      (1)  Provide written notice to enrollees upon enrollment
 
11           with the plan, listing the contraceptive health care
 
12           services they refuse to cover for reason of conscience
 
13           or religion;
 
14      (2)  Provide written information describing how an enrollee
 
15           may directly access prescription contraceptive drugs
 
16           and devices and outpatient contraceptive health care
 
17           services in an expeditious manner; and 
 
18      (3)  Ensure that enrollees who are refused services under
 
19           this section have prompt access to the information
 
20           developed under paragraph (2).  Such notice shall
 
21           appear, in not less than twelve point type, in the
 
22           policy, application, and sales brochure for such
 
23           policy.
 

 
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 1      (d)  Nothing in this section shall be construed as
 
 2 authorizing an individual health insurance policy to exclude
 
 3 coverage for prescription contraceptive drugs or devices ordered
 
 4 by a health care provider with prescriptive authority for reasons
 
 5 other than contraceptive purposes, or for prescription
 
 6 contraception that is necessary to preserve the life or health of
 
 7 an enrollee, such as decreasing the risk of ovarian cancer or
 
 8 eliminating symptoms of menopause.
 
 9      (e)  Health insurers, mutual benefit societies, and health
 
10 maintenance organizations shall allow enrollees in a health plan
 
11 exempted under this section to directly purchase coverage of
 
12 prescription contraceptive drugs and devices and outpatient
 
13 contraceptive services from the health insurer.  The enrollee's
 
14 cost of purchasing such coverage shall not exceed the enrollee's
 
15 pro rata share of the price the group purchaser would have paid
 
16 for such coverage had the group plan not invoked a religious
 
17 exemption.
 
18      (f)  This section shall not be construed as to require a
 
19 health insurer, mutual benefit society, health maintenance
 
20 organization, health care facility, or health care provider to
 
21 provide any health care services without appropriate payment of
 
22 premium or fee."
 

 
 
 
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 1      SECTION 2.  Section 431:10A-116.6, Hawaii Revised Statutes,
 
 2 is amended to read as follows:
 
 3      [[] 431:10A-116.6[]]  Contraceptive services[; options].
 
 4      "(a)  Notwithstanding any provision of law to the contrary,
 
 5 each employer group health policy, contract, plan, or agreement
 
 6 issued or renewed in this State on or after January 1, [1994,
 
 7 that provides for payment of or reimbursement for pregnancy-
 
 8 related services, shall provide as an employer option,] 2000,
 
 9 shall cease to exclude contraceptive services or supplies for the
 
10 subscriber or any dependent of the subscriber who is covered by
 
11 the policy.
 
12      (b)  [Any] Except as provided in subsection (c), all
 
13 policies, contracts, plans, or agreements under subsection (a)
 
14 [above], that provide contraceptive services or supplies, or
 
15 prescription drug coverage, shall not exclude any Food and Drug
 
16 Administration-approved prescriptive contraceptive drug or
 
17 device, or impose any unusual copayment, charge, or waiting
 
18 requirement for such drug or device.
 
19      (c)  Coverage for oral contraceptives shall include at least
 
20 one brand from the monophasic, multiphasic, and the progestin-
 
21 only categories.  A member shall receive coverage for any other
 
22 oral contraceptive only if:
 

 
 
 
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 1      (1)  Use of brands covered has resulted in an adverse drug
 
 2           reaction; or
 
 3      (2)  The member has not used the brands covered and, based
 
 4           on the member's past medical history, the prescribing
 
 5           health care provider believes that use of the brands
 
 6           covered would result in an adverse reaction.
 
 7      [(c)](d)  For [the purpose] purposes of this section[,
 
 8 "contraceptive services"]:
 
 9      "Contraceptive services" means physician-delivered,
 
10 physician-supervised, physician assistant-delivered, nurse
 
11 practitioner-delivered, certified nurse midwife-delivered, or
 
12 nurse-delivered medical services intended to promote the
 
13 effective use of prescription contraceptive supplies or devices
 
14 to prevent unwanted pregnancy.
 
15      "Contraceptive supplies" means all Food and Drug
 
16 Administration-approved contraceptive drugs or devices used to
 
17 prevent unwanted pregnancy."
 
18      [(d)](e)  Nothing in this section shall be construed to 
 
19 extend the practice or privileges of any health care provider
 
20 beyond that provided in the laws governing the provider's
 
21 practice and privileges."
 
22      SECTION 3.  Section 432:1-604.5, Hawaii Revised Statutes, is
 
23 amended to read as follows:
 

 
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                                     H.B. NO.           
                                                        
                                                        

 
 1      "[[]�432:1-604[]]  Contraceptive services [; options].(a)
 
 2 Notwithstanding any provision of law to the contrary, each
 
 3 employer group health policy, contract, plan, or agreement issued
 
 4 or renewed in this State on or after January 1, [1994, that
 
 5 provides for payment of or reimbursement for pregnancy-related
 
 6 services, shall provide as an employer option,] 2000, shall cease
 
 7 to exclude contraceptive services and contraceptive prescription
 
 8 drug coverage or supplies for the subscriber or any dependent of
 
 9 the subscriber who is covered by the policy.
 
10      (b)  [Any] Except as provided in subsection (c), all
 
11 policies, contracts, plans, or agreements under subsection (a),
 
12 that provide contraceptive services or supplies, or prescription
 
13 drug coverage, shall not exclude any [Federal] Food and Drug
 
14 Administration-approved prescriptive contraceptive drug or
 
15 device, or impose any unusual copayment, charge, or waiting
 
16 requirement for such drug or device.
 
17      (c)  Coverage for contraceptives shall include at least one
 
18 brand from the monophasic, multiphasic, and the progestin-only
 
19 categories.  A member shall receive coverage for any other oral
 
20 contraceptive only if:
 
21      (1)  Use of brands covered has resulted in an adverse drug
 
22           reaction; or
 

 
 
 
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                                     H.B. NO.           
                                                        
                                                        

 
 1      (2)  The member has not used the brands covered and, based
 
 2           on the member's past medical history, the prescribing
 
 3           health care provider believes that use of the brands
 
 4           covered would result in an adverse reaction.
 
 5      [(c)](d)  For [the purpose] purposes of this section[,
 
 6 "contraceptive services"]:
 
 7      "Contraceptive services" means physician-delivered,
 
 8 physician-supervised, physician assistant-delivered, nurse
 
 9 practitioner-delivered, certified nurse midwife-delivered, or
 
10 nurse-delivered medical services intended to promote the
 
11 effective use of prescription contraceptive supplies or devices
 
12 to prevent unwanted pregnancy.
 
13      "Contraceptive supplies" means all Food and Drug
 
14 Administration-approved contraceptive drug or device used to
 
15 prevent unwanted pregnancy."
 
16      [(d)](e)  Nothing in this section shall be construed to 
 
17 extend the practice or privileges of any health care provider
 
18 beyond that provided in the laws governing the providers practice
 
19 and privileges."
 
20      SECTION 4.  The legislative reference bureau shall review
 
21 the experience of employers in providing coverage of
 
22 contraceptive services and supplies as part of their health
 
23 insurance coverage for employees after the effective date of this
 

 
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 1 Act to determine whether the cost of health insurance has
 
 2 increased as a result of this Act.  The review shall include an
 
 3 assessment of the impact of contraceptive coverage on reducing
 
 4 maternity costs, employee turnover, and absenteeism costs around
 
 5 maternity and family-related costs.  The insurance providers and
 
 6 business organizations, including the Chamber of Commerce of
 
 7 Hawaii, are requested to assist the legislative reference bureau
 
 8 in obtaining the necessary information from employers to
 
 9 effectuate the review.
 
10      The legislative reference bureau shall submit a report of
 
11 its findings to the legislature no later than twenty days prior
 
12 to the convening of the regular session of    .
 
13      SECTION 5.  Statutory material to be repealed is bracketed.
 
14 New statutory material is underscored.
 
15      SECTION 6.  This Act shall take effect July 1, 2010.