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 HD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        822
THE SENATE                              S.B. NO.           S.D. 2
TWENTIETH LEGISLATURE, 1999                                H.D. 2
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
 
16 without coverage for contraceptive services and supplies that are
 
17 contrary to the religious employer's religious tenets.  If so
 
18 requested, the health insurer, mutual benefit society, or health
 
19 maintenance organization shall provide a health insurance plan
 
20 without coverage for contraceptive services and supplies.  This
 

 
Page 2                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1 subsection shall not be construed to deny an enrollee coverage
 
 2 of, and timely access to contraceptive services and supplies.
 
 3      (c)  Each religious employer that invokes the exemption
 
 4 provided under this section shall:
 
 5      (1)  Provide written notice to enrollees upon enrollment
 
 6           with the plan, listing the contraceptive health care
 
 7           services the employer refuses to cover for religious
 
 8           reasons;
 
 9      (2)  Provide written information describing how an enrollee
 
10           may directly access contraceptive services and supplies
 
11           in an expeditious manner; and 
 
12      (3)  Ensure that enrollees who are refused contraceptive
 
13           services and supplies coverage under this section have
 
14           prompt access to the information developed under
 
15           paragraph (2).  Such notice shall appear, in not less
 
16           than twelve point type, in the policy, application, and
 
17           sales brochure for such policy.
 
18      (d)  Nothing in this section shall be construed to exclude
 
19 coverage for prescription contraceptive supplies ordered by a
 
20 health care provider with prescriptive authority for reasons
 
21 other than contraceptive purposes, such as decreasing the risk of
 
22 ovarian cancer or eliminating symptoms of menopause, or for
 
23 prescription contraception that is necessary to preserve the life
 
24 or health of an enrollee.
 

 
Page 3                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1      (e)  Health insurers, mutual benefit societies, and health
 
 2 maintenance organizations shall allow enrollees in a health plan
 
 3 exempted under this section to directly purchase coverage of
 
 4 contraceptive supplies and outpatient contraceptive services.
 
 5 The enrollee's cost of purchasing such coverage shall not exceed
 
 6 the enrollee's pro rata share of the price the group purchaser
 
 7 would have paid for such coverage had the group plan not invoked
 
 8 a religious exemption.
 
 9      (f)  This section shall not be construed as to require a
 
10 health insurer, mutual benefit society, health maintenance
 
11 organization, health care facility, or health care provider to
 
12 provide any health care services without appropriate payment of
 
13 premium or fee.
 
14      (g)  For purposes of this section:
 
15      "Contraceptive services" means physician-delivered,
 
16 physician-supervised, physician assistant-delivered, nurse
 
17 practitioner-delivered, certified nurse midwife-delivered, or
 
18 nurse-delivered medical services intended to promote the
 
19 effective use of contraceptive supplies or devices to prevent
 
20 unwanted pregnancy.
 
21      "Contraceptive supplies" means all Food and Drug
 
22 Administration-approved contraceptive drugs or devices used to
 
23 prevent unwanted pregnancy."
 

 
Page 4                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 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[.], subject to the exclusion under section 431:10A-  .
 
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,] prescription contraceptive supplies or impose any
 
18 unusual copayment, charge, or waiting requirement for such [drug
 
19 or device.] supplies.
 
20      (c)  Coverage for oral contraceptives shall include at least
 
21 one brand from the monophasic, multiphasic, and the progestin-
 
22 only categories.  A member shall receive coverage for any other
 
23 oral contraceptive only if:
 

 
Page 5                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 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:
 

 
Page 6                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 1      "[[]§432:1-604.5[]]  Contraceptive services [; options].
 
 2 (a)  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 or supplies, and contraceptive
 
 8 prescription drug coverage for the subscriber or any dependent of
 
 9 the subscriber who is covered by the policy[.], subject to the
 
10 exclusion under section 431:10A-   .
 
11      (b)  [Any] Except as provided in subsection (c), all
 
12 policies, contracts, plans, or agreements under subsection (a),
 
13 that provide contraceptive services or supplies, or prescription
 
14 drug coverage, shall not exclude any [Federal Drug
 
15 Administration-approved prescriptive contraceptive drug or
 
16 device,] prescription contraceptive supplies or impose any
 
17 unusual copayment, charge, or waiting requirement for such drug
 
18 or device.
 
19      (c)  Coverage for contraceptives shall include at least one
 
20 brand from the monophasic, multiphasic, and the progestin-only
 
21 categories.  A member shall receive coverage for any other oral
 
22 contraceptive only if:
 

 
 
 
Page 7                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

 
 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 4.  The insurance commissioner shall review the
 
23 experience of employers in providing coverage of contraceptive
 

 
Page 8                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        

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