II 

109TH CONGRESS 

1ST SESSION S. 1214 

To require equitable coverage of prescription contraceptive drugs and devices, 

and contraceptive services under health plans. 

IN THE SENATE OF THE UNITED STATES 

JUNE 9, 2005 

Ms. SNOWE (for herself, Mr. REID, Mr. WARNER, Mr. LEAHY, Mr. CHAFEE, 

Mrs. MURRAY, Mr. KENNEDY, Mr. AKAKA, Mr. DURBIN, Ms. CANTWELL, 

and Mr. LAUTENBERG) introduced the following bill; which was read 

twice and referred to the Committee on Health, Education, Labor, and 

Pensions 

A BILL 

To require equitable coverage of prescription contraceptive 

drugs and devices, and contraceptive services under 

health plans. 

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 2005’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds that— 
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1 (1) each year, over 3,000,000 pregnancies, or 

2 one half of all pregnancies, in the United States are 

3 unintended; 

4 (2) contraceptives and contraceptive services 

5 are part of basic health care, allowing families to 

6 both adequately space desired pregnancies and avoid 

7 unintended pregnancy, and should be provided on 

8 the same terms and conditions as other basic health 

9 care; 

10 (3) studies show that contraceptives are cost ef11 fective: it is estimated that for every $1 of public 

12 funds invested in family planning, $3 is saved in 

13 medicaid costs from pregnancy-related healthcare 

14 and medical care for newborns; 

15 (4) by reducing rates of unintended pregnancy, 

16 contraceptives help reduce abortions; 

17 (5) unintended pregnancies lead to higher rates 

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

19 morbidity, and threaten the economic viability of 

20 families; 

21 (6) the National Commission to Prevent Infant 

22 Mortality determined that ‘‘infant mortality could be 

23 reduced by 10 percent if all women not desiring 

24 pregnancy used contraception’’; 
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1 (7) most women in the United States, including 

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

3 some form of private insurance (through their own 

4 employer, a family member’s employer, or the indi5 vidual market) to defray their medical expenses; 

6 (8) the vast majority of private insurers cover 

7 prescription drugs, but many continue to exclude 

8 coverage for prescription contraceptives; 

9 (9) women of reproductive age spend 68 per10 cent more than men on out-of-pocket health care 

11 costs, with contraceptives and reproductive health 

12 care services accounting for much of the difference; 

13 (10) the lack of contraceptive coverage in health 

14 insurance places many effective forms of contracep15 tives beyond the financial reach of many women, 

16 leading to unintended pregnancies; 

17 (11) the Institute of Medicine Committee on 

18 Unintended Pregnancy recommended that ‘‘financial 

19 barriers to contraception be reduced by increasing 

20 the proportion of all health insurance policies that 

21 cover contraceptive services and supplies’’; 

22 (12) in 1998, Congress agreed to provide con23 traceptive coverage to women of reproductive age 

24 who are participating in the Federal Employees 

25 Health Benefits Program, the largest employer-spon-
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1 sored health insurance plan in the world, and in 

2 2001, the Office of Personnel Management reported 

3 that it did not raise premiums as a result of such 

4 coverage because there was ‘‘no cost increase due to 

5 contraceptive coverage’’; 

6 (13) contraceptive coverage saves employers 

7 money: the Washington Business Group on Health 

8 estimates that not covering contraceptives in em9 ployee health plans costs employers 15 to 17 percent 

10 more than providing such coverage; 

11 (14) eight in 10 privately insured adults sup12 port contraceptive coverage; and 

13 (15) Healthy People 2010, published by the Of14 fice of the Surgeon General, has established a 10- 

15 year national public health goal to increase the per16 centage of health plans that cover contraceptives. 

17 SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN18 COME SECURITY ACT OF 1974. 

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

20 B of title I of the Employee Retirement Income Security 

21 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add22 ing at the end the following: 
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1 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR CON2 TRACEPTIVES. 

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

4 health plan, and a health insurance issuer providing health 

5 insurance coverage in connection with a group health plan, 

6 may not— 

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

8 contraceptive drugs or devices approved by the Food 

9 and Drug Administration, or generic equivalents ap10 proved as substitutable by the Food and Drug Ad11 ministration, if such plan or coverage provides bene12 fits for other outpatient prescription drugs or de13 vices; or 

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

15 contraceptive services if such plan or coverage pro16 vides benefits for other outpatient services provided 

17 by a health care professional (referred to in this sec18 tion as ‘outpatient health care services’). 

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

20 health insurance issuer providing health insurance cov21 erage in connection with a group health plan, may not— 

22 ‘‘(1) deny to an individual eligibility, or contin23 ued eligibility, to enroll or to renew coverage under 

24 the terms of the plan because of the individual’s or 

25 enrollee’s use or potential use of items or services 
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1 that are covered in accordance with the requirements 

2 of this section; 

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

4 a covered individual to encourage such individual to 

5 accept less than the minimum protections available 

6 under this section; 

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

8 reimbursement of a health care professional because 

9 such professional prescribed contraceptive drugs or 

10 devices, or provided contraceptive services, described 

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

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

13 to a health care professional to induce such profes14 sional to withhold from a covered individual contra15 ceptive drugs or devices, or contraceptive services, 

16 described in subsection (a). 

17 ‘‘(c) RULES OF CONSTRUCTION.— 

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

19 shall be construed— 

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

21 and a health insurance issuer providing health 

22 insurance coverage in connection with a group 

23 health plan from imposing deductibles, coinsur24 ance, or other cost-sharing or limitations in re25 lation to— 
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1 ‘‘(i) benefits for contraceptive drugs 

2 under the plan or coverage, except that 

3 such a deductible, coinsurance, or other 

4 cost-sharing or limitation for any such 

5 drug shall be consistent with those imposed 

6 for other outpatient prescription drugs oth7 erwise covered under the plan or coverage; 

8 ‘‘(ii) benefits for contraceptive devices 

9 under the plan or coverage, except that 

10 such a deductible, coinsurance, or other 

11 cost-sharing or limitation for any such de12 vice shall be consistent with those imposed 

13 for other outpatient prescription devices 

14 otherwise covered under the plan or cov15 erage; and 

16 ‘‘(iii) benefits for outpatient contra17 ceptive services under the plan or coverage, 

18 except that such a deductible, coinsurance, 

19 or other cost-sharing or limitation for any 

20 such service shall be consistent with those 

21 imposed for other outpatient health care 

22 services otherwise covered under the plan 

23 or coverage; 

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

25 a health insurance issuer providing health in-
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1 surance coverage in connection with a group 

2 health plan to cover experimental or investiga3 tional contraceptive drugs or devices, or experi4 mental or investigational contraceptive services, 

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

6 that the plan or issuer provides coverage for 

7 other experimental or investigational outpatient 

8 prescription drugs or devices, or experimental 

9 or investigational outpatient health care serv10 ices; or 

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

12 the rights or protections of an individual under 

13 any other Federal law. 

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

15 the term ‘limitation’ includes— 

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

17 device, restricting the type of health care pro18 fessionals that may prescribe such drugs or de19 vices, utilization review provisions, and limits on 

20 the volume of prescription drugs or devices that 

21 may be obtained on the basis of a single con22 sultation with a professional; or 

23 ‘‘(B) in the case of an outpatient contra24 ceptive service, restricting the type of health 

25 care professionals that may provide such serv-
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1 ices, utilization review provisions, requirements 

2 relating to second opinions prior to the coverage 

3 of such services, and requirements relating to 

4 preauthorizations prior to the coverage of such 

5 services. 

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

7 imposition of the requirements of this section shall be 

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

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

10 notice of such requirements under the plan, except that 

11 the summary description required to be provided under the 

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

13 modification shall be provided by not later than 60 days 

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

15 requirements apply. 

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

17 construed to preempt any provision of State law to the 

18 extent that such State law establishes, implements, or con19 tinues in effect any standard or requirement that provides 

20 coverage or protections for participants or beneficiaries 

21 that are greater than the coverage or protections provided 

22 under this section. 

23 ‘‘(f) DEFINITION.—In this section, the term ‘out24 patient contraceptive services’ means consultations, exami25 nations, procedures, and medical services, provided on an 
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1 outpatient basis and related to the use of contraceptive 

2 methods (including natural family planning) to prevent an 

3 unintended pregnancy.’’. 

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

5 in section 1 of the Employee Retirement Income Security 

6 Act of 1974 (29 U.S.C. 1001) is amended by inserting 

7 after the item relating to section 713 the following: 

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

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

9 this section shall apply with respect to plan years begin10 ning on or after January 1, 2006. 

11 SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 

12 ACT RELATING TO THE GROUP MARKET. 

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

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

15 300gg–4 et seq.) is amended by adding at the end the 

16 following: 

17 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CON18 TRACEPTIVES. 

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

20 health plan, and a health insurance issuer providing health 

21 insurance coverage in connection with a group health plan, 

22 may not— 

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

24 contraceptive drugs or devices approved by the Food 

25 and Drug Administration, or generic equivalents ap-
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1 proved as substitutable by the Food and Drug Ad2 ministration, if such plan or coverage provides bene3 fits for other outpatient prescription drugs or de4 vices; or 

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

6 contraceptive services if such plan or coverage pro7 vides benefits for other outpatient services provided 

8 by a health care professional (referred to in this sec9 tion as ‘outpatient health care services’). 

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

11 health insurance issuer providing health insurance cov12 erage in connection with a group health plan, may not— 

13 ‘‘(1) deny to an individual eligibility, or contin14 ued eligibility, to enroll or to renew coverage under 

15 the terms of the plan because of the individual’s or 

16 enrollee’s use or potential use of items or services 

17 that are covered in accordance with the requirements 

18 of this section; 

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

20 a covered individual to encourage such individual to 

21 accept less than the minimum protections available 

22 under this section; 

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

24 reimbursement of a health care professional because 

25 such professional prescribed contraceptive drugs or 
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1 devices, or provided contraceptive services, described 

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

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

4 to a health care professional to induce such profes5 sional to withhold from covered individual contracep6 tive drugs or devices, or contraceptive services, de7 scribed in subsection (a). 

8 ‘‘(c) RULES OF CONSTRUCTION.— 

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

10 shall be construed— 

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

12 and a health insurance issuer providing health 

13 insurance coverage in connection with a group 

14 health plan from imposing deductibles, coinsur15 ance, or other cost-sharing or limitations in re16 lation to— 

17 ‘‘(i) benefits for contraceptive drugs 

18 under the plan or coverage, except that 

19 such a deductible, coinsurance, or other 

20 cost-sharing or limitation for any such 

21 drug shall be consistent with those imposed 

22 for other outpatient prescription drugs oth23 erwise covered under the plan or coverage; 

24 ‘‘(ii) benefits for contraceptive devices 

25 under the plan or coverage, except that 
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1 such a deductible, coinsurance, or other 

2 cost-sharing or limitation for any such de3 vice shall be consistent with those imposed 

4 for other outpatient prescription devices 

5 otherwise covered under the plan or cov6 erage; and 

7 ‘‘(iii) benefits for outpatient contra8 ceptive services under the plan or coverage, 

9 except that such a deductible, coinsurance, 

10 or other cost-sharing or limitation for any 

11 such service shall be consistent with those 

12 imposed for other outpatient health care 

13 services otherwise covered under the plan 

14 or coverage; 

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

16 a health insurance issuer providing health in17 surance coverage in connection with a group 

18 health plan to cover experimental or investiga19 tional contraceptive drugs or devices, or experi20 mental or investigational contraceptive services, 

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

22 that the plan or issuer provides coverage for 

23 other experimental or investigational outpatient 

24 prescription drugs or devices, or experimental 
14 

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1 or investigational outpatient health care serv2 ices; or 

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

4 the rights or protections of an individual under 

5 any other Federal law. 

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

7 the term ‘limitation’ includes— 

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

9 device, restricting the type of health care pro10 fessionals that may prescribe such drugs or de11 vices, utilization review provisions, and limits on 

12 the volume of prescription drugs or devices that 

13 may be obtained on the basis of a single con14 sultation with a professional; or 

15 ‘‘(B) in the case of an outpatient contra16 ceptive service, restricting the type of health 

17 care professionals that may provide such serv18 ices, utilization review provisions, requirements 

19 relating to second opinions prior to the coverage 

20 of such services, and requirements relating to 

21 preauthorizations prior to the coverage of such 

22 services. 

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

24 shall comply with the notice requirement under section 

25 714(d) of the Employee Retirement Income Security Act 
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1 of 1974 with respect to the requirements of this section 

2 as if such section applied to such plan. 

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 enrollees that are greater than 

8 the coverage or protections provided under this section. 

9 ‘‘(f) DEFINITION.—In this section, the term ‘out10 patient contraceptive services’ means consultations, exami11 nations, procedures, and medical services, provided on an 

12 outpatient basis and related to the use of contraceptive 

13 methods (including natural family planning) to prevent an 

14 unintended pregnancy.’’. 

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

16 this section shall apply with respect to group health plans 

17 for plan years beginning on or after January 1, 2006. 

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

19 RELATING TO THE INDIVIDUAL MARKET. 

20 (a) IN GENERAL.—Part B of title XXVII of the Pub21 lic Health Service Act (42 U.S.C. 300gg–41 et seq.) is 

22 amended— 

23 (1) by redesignating the first subpart 3 (relat24 ing to other requirements) as subpart 2; and 
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1 (2) by adding at the end of subpart 2 the fol2 lowing: 

3 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CON4 TRACEPTIVES. 

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

6 insurance coverage offered by a health insurance issuer 

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

8 to health insurance coverage offered by a health insurance 

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

10 or large group market.’’. 

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

12 this section shall apply with respect to health insurance 

13 coverage offered, sold, issued, renewed, in effect, or oper14 ated in the individual market on or after January 1, 2006. 

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