I 

108TH CONGRESS 

1ST SESSION H. R. 2727

To require equitable coverage of prescription contraceptive drugs and devices, 

and contraceptive services under health plans. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 15, 2003

Mr. GREENWOOD (for himself, Mrs. LOWEY, Mr. GUTIERREZ, Mr. HOEFFEL, 

Ms. NORTON, Ms. BALDWIN, Mr. HINCHEY, Mr. FRANK of Massachusetts, Mr. SANDERS, Mr. ROTHMAN, Mr. GEORGE MILLER of California, 

Ms. SCHAKOWSKY, Mr. BROWN of Ohio, Ms. ESHOO, Mr. CUMMINGS, 

Mrs. CAPPS, Mr. WAXMAN, Ms. SLAUGHTER, Ms. CORRINE BROWN of 

Florida, Mr. GREEN of Texas, Mr. NADLER, Mr. OWENS, Mrs. KELLY, 

Mr. BAIRD, Mr. PASCRELL, Ms. WOOLSEY, Mr. MATHESON, Mr. 

MCDERMOTT, Mr. LEVIN, Mr. SCOTT of Georgia, Mr. FILNER, Mr. RANGEL, Mr. CONYERS, Mr. FROST, Mr. WU, Mr. HOLT, Mrs. NAPOLITANO, 

Ms. VELA ́ZQUEZ, Mr. BELL, Ms. MILLENDER-MCDONALD, Mr. SHAYS, 

Ms. MCCOLLUM, Mr. VISCLOSKY, Mr. BLUMENAUER, Mr. ENGEL, Mr. 

DOYLE, Mr. DAVIS of Illinois, Ms. JACKSON-LEE of Texas, Mr. MORAN

of Virginia, Mr. GRIJALVA, Mr. MICHAUD, Mr. FALEOMAVAEGA, Mr. 

DAVIS of Alabama, Mr. BRADY of Pennsylvania, Ms. DEGETTE, Mr. OSE, 

and Mrs. JOHNSON of Connecticut) introduced the following bill; which 

was referred to the Committee on Energy and Commerce, and in addition 

to the Committee on Education and the Workforce, for a period to be 

subsequently determined by the Speaker, in each case for consideration 

of such provisions as fall within the jurisdiction of the committee concerned 

A BILL

To require equitable coverage of prescription contraceptive 

drugs and devices, and contraceptive services under 

health plans.

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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Equity in Prescription 

5 Insurance and Contraceptive Coverage Act of 2003’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds that—

8 (1) each year, 3,000,000 pregnancies, or one 

9 half of all pregnancies, in this country are unin10 tended; 

11 (2) contraceptives and contraceptive services 

12 are part of basic health care, allowing families to 

13 both adequately space desired pregnancies and avoid 

14 unintended pregnancy, and should be provided under 

15 the same terms and conditions as other basic health 

16 care; 

17 (3) studies show that contraceptives are cost ef18 fective: for every $1 of public funds invested in fam19 ily planning, $4 to $14 of public funds is saved in 

20 pregnancy and health care-related costs; 

21 (4) by reducing rates of unintended pregnancy, 

22 contraceptives help reduce the need for abortion; 

23 (5) unintended pregnancies lead to higher rates 

24 of infant mortality, low-birth weight, and maternal 

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1 morbidity, and threaten the economic viability of 

2 families; 

3 (6) the National Commission to Prevent Infant 

4 Mortality determined that ‘‘infant mortality could be 

5 reduced by 10 percent if all women not desiring 

6 pregnancy used contraception’’; 

7 (7) most women in the United States, including 

8 three-quarters of women of childbearing age, rely on 

9 some form of private insurance (through their own 

10 employer, a family member’s employer, or the indi11 vidual market) to defray their medical expenses; 

12 (8) the vast majority of private insurers cover 

13 prescription drugs, but many exclude coverage for 

14 prescription contraceptives; 

15 (9) private insurance provides extremely limited 

16 coverage of contraceptives: half of traditional indem17 nity plans and preferred provider organizations, 20 

18 percent of point-of-service networks, and 7 percent 

19 of health maintenance organizations cover no contra20 ceptive methods other than sterilization; 

21 (10) women of reproductive age spend 68 per22 cent more than men on out-of-pocket health care 

23 costs, with contraceptives and reproductive health 

24 care services accounting for much of the difference; 

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1 (11) the lack of contraceptive coverage in health 

2 insurance places many effective forms of contracep3 tives beyond the financial reach of many women, 

4 leading to unintended pregnancies; 

5 (12) the Institute of Medicine Committee on 

6 Unintended Pregnancy recommended that ‘‘financial 

7 barriers to contraception be reduced by increasing 

8 the proportion of all health insurance policies that 

9 cover contraceptive services and supplies’’; 

10 (13) in 1998, Congress agreed to provide con11 traceptive coverage to the 2,000,000 women of re12 productive age who are participating in the Federal 

13 Employees Health Benefits Program, the largest 

14 employer-sponsored health insurance plan in the 

15 world, and, in 2001, the Office of Personnel Man16 agement reported that it did not raise premiums as 

17 a result of such coverage because there was ‘‘no cost 

18 increase due to contraceptive coverage’’ ; 

19 (14) eight in 10 privately insured adults sup20 port contraceptive coverage; 

21 (15) contraceptive coverage saves employers 

22 money: the Washington Business Group on Health 

23 estimates that not covering contraceptives in em24 ployee health plans costs employers 15 to 17 percent 

25 more than providing such coverage; and 

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1 (16) Healthy People 2010, published by the Of2 fice of the Surgeon General, has established a 10-

3 year national public health goal to increase the per4 centage of health plans that cover contraceptives . 

5 SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN6 COME SECURITY ACT OF 1974. 

7 (a) IN GENERAL.—Subpart B of part 7 of subtitle 

8 B of title I of the Employee Retirement Income Security 

9 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add10 ing at the end the following new section: 

11 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR CON12 TRACEPTIVES. 

13 ‘‘(a) REQUIREMENTS FOR COVERAGE.—A group 

14 health plan, and a health insurance issuer providing health 

15 insurance coverage in connection with a group health plan, 

16 may not—

17 ‘‘(1) exclude or restrict benefits for prescription 

18 contraceptive drugs or devices approved by the Food 

19 and Drug Administration, or generic equivalents ap20 proved as substitutable by the Food and Drug Ad21 ministration, if such plan or coverage provides bene22 fits for other outpatient prescription drugs or de23 vices; or 

24 ‘‘(2) exclude or restrict benefits for outpatient 

25 contraceptive services if such plan or coverage proVerDate Jan 31 2003 07:57 Jul 16, 2003 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2727.IH H2727
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1 vides benefits for other outpatient services provided 

2 by a health care professional (referred to in this sec3 tion as ‘outpatient health care services’). 

4 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

5 health insurance issuer providing health insurance cov6 erage in connection with a group health plan, may not—

7 ‘‘(1) deny to an individual eligibility, or contin8 ued eligibility, to enroll or to renew coverage under 

9 the terms of the plan or coverage because of the in10 dividual’s or enrollee’s use or potential use of items 

11 or services that are covered in accordance with the 

12 requirements of this section; 

13 ‘‘(2) provide monetary payments or rebates to 

14 a covered individual to encourage such individual to 

15 accept less than the minimum protections available 

16 under this section; 

17 ‘‘(3) penalize or otherwise reduce or limit the 

18 reimbursement of a health care professional because 

19 such professional prescribed contraceptive drugs or 

20 devices, or provided contraceptive services, described 

21 in subsection (a), in accordance with this section; or 

22 ‘‘(4) provide incentives (monetary or otherwise) 

23 to a health care professional to induce such profes24 sional to withhold from a covered individual contraVerDate Jan 31 2003 07:57 Jul 16, 2003 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2727.IH H2727
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1 ceptive drugs or devices, or contraceptive services, 

2 described in subsection (a). 

3 ‘‘(c) RULES OF CONSTRUCTION.—

4 ‘‘(1) IN GENERAL.—Nothing in this section 

5 shall be construed—

6 ‘‘(A) as preventing a group health plan 

7 and a health insurance issuer providing health 

8 insurance coverage in connection with a group 

9 health plan from imposing deductibles, coinsur10 ance, or other cost-sharing or limitations in re11 lation to—

12 ‘‘(i) benefits for contraceptive drugs 

13 under the plan or coverage, except that 

14 such a deductible, coinsurance, or other 

15 cost-sharing or limitation for any such 

16 drug shall be consistent with those imposed 

17 for any outpatient prescription drug other18 wise covered under the plan or coverage; 

19 ‘‘(ii) benefits for contraceptive devices 

20 under the plan or coverage, except that 

21 such a deductible, coinsurance, or other 

22 cost-sharing or limitation for any such de23 vice shall be consistent with those imposed 

24 for any outpatient prescription device othVerDate Jan 31 2003 07:57 Jul 16, 2003 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2727.IH H2727
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1 erwise covered under the plan or coverage; 

2 and 

3 ‘‘(iii) benefits for outpatient contra4 ceptive services under the plan or coverage, 

5 except that such a deductible, coinsurance, 

6 or other cost-sharing or limitation for any 

7 such service shall be consistent with those 

8 imposed for any outpatient health care 

9 service otherwise covered under the plan or 

10 coverage; 

11 ‘‘(B) as requiring a group health plan and 

12 a health insurance issuer providing health in13 surance coverage in connection with a group 

14 health plan to cover experimental or investiga15 tional contraceptive drugs or devices, or experi16 mental or investigational contraceptive services, 

17 described in subsection (a), except to the extent 

18 that the plan or issuer provides coverage for 

19 other experimental or investigational outpatient 

20 prescription drugs or devices, or experimental 

21 or investigational outpatient health care serv22 ices; or 

23 ‘‘(C) as modifying, diminishing, or limiting 

24 the rights and protections of an individual 

25 under any other Federal law. 

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1 ‘‘(2) LIMITATIONS.—As used in paragraph (1), 

2 the term ‘limitation’ includes—

3 ‘‘(A) in the case of a contraceptive drug or 

4 device, restricting the type of health care pro5 fessionals that may prescribe such drugs or de6 vices, utilization review provisions, and limits on 

7 the volume of prescription drugs or devices that 

8 may be obtained on the basis of a single con9 sultation with a professional; or 

10 ‘‘(B) in the case of an outpatient contra11 ceptive service, restricting the type of health 

12 care professionals that may provide such serv13 ices, utilization review provisions, requirements 

14 relating to second opinions prior to the coverage 

15 of such services, and requirements relating to 

16 preauthorizations prior to the coverage of such 

17 services. 

18 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The 

19 imposition of the requirements of this section shall be 

20 treated as a material modification in the terms of the plan 

21 described in section 102(a)(1), for purposes of assuring 

22 notice of such requirements under the plan, except that 

23 the summary description required to be provided under the 

24 last sentence of section 104(b)(1) with respect to such 

25 modification shall be provided by not later than 60 days 

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1 after the first day of the first plan year in which such 

2 requirements apply. 

3 ‘‘(e) PREEMPTION.—Nothing in this section shall be 

4 construed to preempt any provision of State law to the 

5 extent that such State law establishes, implements, or con6 tinues in effect any standard or requirement that provides 

7 coverage or protections for participants or beneficiaries 

8 that are greater than the coverage or protections provided 

9 under this section. 

10 ‘‘(f) DEFINITION.—In this section, the term ‘out11 patient contraceptive services’ means consultations, exami12 nations, procedures, and medical services, provided on an 

13 outpatient basis and related to the use of contraceptive 

14 methods (including natural family planning) to prevent an 

15 unintended pregnancy.’’. 

16 (b) CLERICAL AMENDMENT.—The table of contents 

17 in section 1 of the Employee Retirement Income Security 

18 Act of 1974 (29 U.S.C. 1001 note) is amended by insert19 ing after the item relating to section 713 the following 

20 new item:

‘‘714. Standards relating to benefits for contraceptives.’’.

21 (c) EFFECTIVE DATE.—The amendments made by 

22 this section shall apply with respect to plan years begin23 ning on or after January 1, 2005. 

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1 SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 

2 ACT RELATING TO THE GROUP MARKET. 

3 (a) IN GENERAL.—Subpart 2 of part A of title 

4 XXVII of the Public Health Service Act (42 U.S.C. 

5 300gg–4 et seq.) is amended by adding at the end the 

6 following new section: 

7 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CON8 TRACEPTIVES. 

9 ‘‘(a) REQUIREMENTS FOR COVERAGE.—A group 

10 health plan, and a health insurance issuer providing health 

11 insurance coverage in connection with a group health plan, 

12 may not—

13 ‘‘(1) exclude or restrict benefits for prescription 

14 contraceptive drugs or devices approved by the Food 

15 and Drug Administration, or generic equivalents ap16 proved as substitutable by the Food and Drug Ad17 ministration, if such plan or coverage provides bene18 fits for other outpatient prescription drugs or de19 vices; or 

20 ‘‘(2) exclude or restrict benefits for outpatient 

21 contraceptive services if such plan or coverage pro22 vides benefits for other outpatient services provided 

23 by a health care professional (referred to in this sec24 tion as ‘outpatient health care services’). 

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1 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

2 health insurance issuer providing health insurance cov3 erage in connection with a group health plan, may not—

4 ‘‘(1) deny to an individual eligibility, or contin5 ued eligibility, to enroll or to renew coverage under 

6 the terms of the plan or coverage because of the in7 dividual’s or enrollee’s use or potential use of items 

8 or services that are covered in accordance with the 

9 requirements of this section; 

10 ‘‘(2) provide monetary payments or rebates to 

11 a covered individual to encourage such individual to 

12 accept less than the minimum protections available 

13 under this section; 

14 ‘‘(3) penalize or otherwise reduce or limit the 

15 reimbursement of a health care professional because 

16 such professional prescribed contraceptive drugs or 

17 devices, or provided contraceptive services, described 

18 in subsection (a), in accordance with this section; or 

19 ‘‘(4) provide incentives (monetary or otherwise) 

20 to a health care professional to induce such profes21 sional to withhold from covered individual contracep22 tive drugs or devices, or contraceptive services, de23 scribed in subsection (a). 

24 ‘‘(c) RULES OF CONSTRUCTION.—

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1 ‘‘(1) IN GENERAL.—Nothing in this section 

2 shall be construed—

3 ‘‘(A) as preventing a group health plan 

4 and a health insurance issuer providing health 

5 insurance coverage in connection with a group 

6 health plan from imposing deductibles, coinsur7 ance, or other cost-sharing or limitations in re8 lation to—

9 ‘‘(i) benefits for contraceptive drugs 

10 under the plan or coverage, except that 

11 such a deductible, coinsurance, or other 

12 cost-sharing or limitation for any such 

13 drug shall be consistent with those imposed 

14 for any outpatient prescription drug other15 wise covered under the plan or coverage; 

16 ‘‘(ii) benefits for contraceptive devices 

17 under the plan or coverage, except that 

18 such a deductible, coinsurance, or other 

19 cost-sharing or limitation for any such de20 vice shall be consistent with those imposed 

21 for any outpatient prescription device oth22 erwise covered under the plan or coverage; 

23 and 

24 ‘‘(iii) benefits for outpatient contra25 ceptive services under the plan or coverage, 

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1 except that such a deductible, coinsurance, 

2 or other cost-sharing or limitation for any 

3 such service shall be consistent with those 

4 imposed for any outpatient health care 

5 service otherwise covered under the plan or 

6 coverage; 

7 ‘‘(B) as requiring a group health plan and 

8 a health insurance issuer providing health in9 surance coverage in connection with a group 

10 health plan to cover experimental or investiga11 tional contraceptive drugs or devices, or experi12 mental or investigational contraceptive services, 

13 described in subsection (a), except to the extent 

14 that the plan or issuer provides coverage for 

15 other experimental or investigational outpatient 

16 prescription drugs or devices, or experimental 

17 or investigational outpatient health care serv18 ices; or 

19 ‘‘(C) as modifying, diminishing, or limiting 

20 the rights and protections of an individual 

21 under any other Federal law. 

22 ‘‘(2) LIMITATIONS.—As used in paragraph (1), 

23 the term ‘limitation’ includes—

24 ‘‘(A) in the case of a contraceptive drug or 

25 device, restricting the type of health care proVerDate Jan 31 2003 07:57 Jul 16, 2003 Jkt 019200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H2727.IH H2727
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1 fessionals that may prescribe such drugs or de2 vices, utilization review provisions, and limits on 

3 the volume of prescription drugs or devices that 

4 may be obtained on the basis of a single con5 sultation with a professional; or 

6 ‘‘(B) in the case of an outpatient contra7 ceptive service, restricting the type of health 

8 care professionals that may provide such serv9 ices, utilization review provisions, requirements 

10 relating to second opinions prior to the coverage 

11 of such services, and requirements relating to 

12 preauthorizations prior to the coverage of such 

13 services. 

14 ‘‘(d) NOTICE.—A group health plan under this part 

15 shall comply with the notice requirement under section 

16 714(d) of the Employee Retirement Income Security Act 

17 of 1974 with respect to the requirements of this section 

18 as if such section applied to such plan. 

19 ‘‘(e) PREEMPTION.—Nothing in this section shall be 

20 construed to preempt any provision of State law to the 

21 extent that such State law establishes, implements, or con22 tinues in effect any standard or requirement that provides 

23 coverage or protections for enrollees that are greater than 

24 the coverage or protections provided under this section. 

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1 ‘‘(f) DEFINITION.—In this section, the term ‘out2 patient contraceptive services’ means consultations, exami3 nations, procedures, and medical services, provided on an 

4 outpatient basis and related to the use of contraceptive 

5 methods (including natural family planning) to prevent an 

6 unintended pregnancy.’’. 

7 (b) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply with respect to group health plans 

9 for plan years beginning on or after January 1, 2005. 

10 SEC. 5. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT 

11 RELATING TO THE INDIVIDUAL MARKET. 

12 (a) IN GENERAL.—Part B of title XXVII of the Pub13 lic Health Service Act (42 U.S.C. 300gg–41 et seq.) is 

14 amended—

15 (1) by redesignating the first subpart 3 (relat16 ing to other requirements) as subpart 2; and 

17 (2) by adding at the end of subpart 2 the fol18 lowing new section: 

19 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CON20 TRACEPTIVES. 

21 ‘‘The provisions of section 2707 shall apply to health 

22 insurance coverage offered by a health insurance issuer 

23 in the individual market in the same manner as they apply 

24 to health insurance coverage offered by a health insurance 

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1 issuer in connection with a group health plan in the small 

2 or large group market.’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 this section shall apply with respect to health insurance 

5 coverage offered, sold, issued, renewed, in effect, or oper6 ated in the individual market on or after January 1, 2005.

Æ