I

107TH CONGRESS

1ST SESSION H. R. 1111

To require equitable coverage of prescription contraceptive drugs and devices,

and contraceptive services under health plans.

IN THE HOUSE OF REPRESENTATIVES

MARCH 20, 2001

Mr. GREENWOOD (for himself, Mrs. LOWEY, Mrs. JOHNSON of Connecticut,

Mrs. MCCARTHY of New York, Mrs. ROUKEMA, Mr. WEINER, Mr. SHAYS,

Mrs. TAUSCHER, Mr. OSE, Mrs. THURMAN, Mr. BOEHLERT, Ms.

SCHAKOWSKY, Mr. BLAGOJEVICH, Ms. WOOLSEY, Mrs. KELLY, Mr.

LARSEN of Washington, Mr. TIERNEY, Mr. ALLEN, Mrs. JONES of Ohio,

Mr. SANDERS, Mr. BALDACCI, Mr. INSLEE, Mr. STARK, Mr. HINCHEY,

Mr. BRADY of Pennsylvania, Mr. FRANK, Mr. OLVER, Mr. BONIOR, Mr.

BENTSEN, Mr. ABERCROMBIE, Mr. PRICE of North Carolina, Mr. BARRETT, Mr. HOLT, Ms. HOOLEY of Oregon, Mr. BERMAN, Ms. HARMAN,

Ms. SOLIS, Ms. DELAURO, Mr. MORAN of Virginia, Mr. FILNER, Mr.

CAPUANO, Mr. BLUMENAUER, Ms. SANCHEZ, Mr. MCGOVERN, Ms.

BALDWIN, Ms. SLAUGHTER, Ms. PELOSI, Mr. DEFAZIO, Mr. SCHIFF, Mr.

JEFFERSON, Mr. PAYNE, Mr. CROWLEY, Mr. NADLER, Mr. HOEFFEL,

Mr. GONZALEZ, Mr. EVANS, Mr. MCDERMOTT, Mr. RODRIGUEZ, Ms.

MCCARTHY of Missouri, Mr. THOMPSON of California, Mr. CUMMINGS,

and Mr. GEORGE MILLER of California) introduced the following bill;

which was referred to the Committee on Education and the Workforce,

and in addition to the Committee on Energy and Commerce, 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 2001’’.

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) contraceptive services are part of basic

12 health care, allowing families to both adequately

13 space desired pregnancies and avoid unintended

14 pregnancy;

15 (3) studies show that contraceptives are cost ef16 fective: for every $1 of public funds invested in fam17 ily planning, $4 to $14 of public funds is saved in

18 pregnancy and health care-related costs;

19 (4) by reducing rates of unintended pregnancy,

20 contraceptives help reduce the need for abortion;

21 (5) unintended pregnancies lead to higher rates

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

23 morbidity, and threaten the economic viability of

24 families;
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1 (6) the National Commission to Prevent Infant

2 Mortality determined that ‘‘infant mortality could be

3 reduced by 10 percent if all women not desiring

4 pregnancy used contraception’’;

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

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

7 some form of private insurance (through their own

8 employer, a family member’s employer, or the indi9 vidual market) to defray their medical expenses;

10 (8) the vast majority of private insurers cover

11 prescription drugs, but many exclude coverage for

12 prescription contraceptives;

13 (9) private insurance provides extremely limited

14 coverage of contraceptives: half of traditional indem15 nity plans and preferred provider organizations, 20

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

17 of health maintenance organizations cover no contra18 ceptive methods other than sterilization;

19 (10) women of reproductive age spend 68 per20 cent more than men on out-of-pocket health care

21 costs, with contraceptives and reproductive health

22 care services accounting for much of the difference;

23 (11) the lack of contraceptive coverage in health

24 insurance places many effective forms of contracep-
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1 tives beyond the financial reach of many women,

2 leading to unintended pregnancies;

3 (12) the Institute of Medicine Committee on

4 Unintended Pregnancy recommended that ‘‘financial

5 barriers to contraception be reduced by increasing

6 the proportion of all health insurance policies that

7 cover contraceptive services and supplies’’;

8 (13) in 1998, Congress agreed to provide con9 traceptive coverage to the 1,200,000 women of re10 productive age who are participating in the Federal

11 Employees Health Benefits Program, the largest

12 employer-sponsored health insurance plan in the

13 world; and

14 (14) eight in 10 privately insured adults sup15 port contraceptive coverage.

16 SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN17 COME SECURITY ACT OF 1974.

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

19 B of title I of the Employee Retirement Income Security

20 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add21 ing at the end the following new section:

22 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR CON23 TRACEPTIVES.

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

25 health plan, and a health insurance issuer providing health
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1 insurance coverage in connection with a group health plan,

2 may not—

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

4 contraceptive drugs or devices approved by the Food

5 and Drug Administration, or generic equivalents ap6 proved as substitutable by the Food and Drug Ad7 ministration, if such plan provides benefits for other

8 outpatient prescription drugs or devices; or

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

10 contraceptive services if such plan provides benefits

11 for other outpatient services provided by a health

12 care professional (referred to in this section as ‘out13 patient health care services’).

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

15 health insurance issuer providing health insurance cov16 erage in connection with a group health plan, may not—

17 ‘‘(1) deny to an individual eligibility, or contin18 ued eligibility, to enroll or to renew coverage under

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

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

21 that are covered in accordance with the requirements

22 of this section;

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

24 a covered individual to encourage such individual to
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1 accept less than the minimum protections available

2 under this section;

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

4 reimbursement of a health care professional because

5 such professional prescribed contraceptive drugs or

6 devices, or provided contraceptive services, described

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

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

9 to a health care professional to induce such profes10 sional to withhold from a covered individual contra11 ceptive drugs or devices, or contraceptive services,

12 described in subsection (a).

13 ‘‘(c) RULES OF CONSTRUCTION.—

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

15 shall be construed—

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

17 and a health insurance issuer providing health

18 insurance coverage in connection with a group

19 health plan from imposing deductibles, coinsur20 ance, or other cost-sharing or limitations in re21 lation to—

22 ‘‘(i) benefits for contraceptive drugs

23 under the plan, except that such a deduct24 ible, coinsurance, or other cost-sharing or

25 limitation for any such drug may not be
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1 greater than such a deductible, coinsur2 ance, or cost-sharing or limitation for any

3 outpatient prescription drug otherwise cov4 ered under the plan;

5 ‘‘(ii) benefits for contraceptive devices

6 under the plan, except that such a deduct7 ible, coinsurance, or other cost-sharing or

8 limitation for any such device may not be

9 greater than such a deductible, coinsur10 ance, or cost-sharing or limitation for any

11 outpatient prescription device otherwise

12 covered under the plan; and

13 ‘‘(iii) benefits for outpatient contra14 ceptive services under the plan, except that

15 such a deductible, coinsurance, or other

16 cost-sharing or limitation for any such

17 service may not be greater than such a de18 ductible, coinsurance, or cost-sharing or

19 limitation for any outpatient health care

20 service otherwise covered under the plan;

21 and

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

23 a health insurance issuer providing health in24 surance coverage in connection with a group

25 health plan to cover experimental or investiga-
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1 tional contraceptive drugs or devices, or experi2 mental or investigational contraceptive services,

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

4 that the plan or issuer provides coverage for

5 other experimental or investigational outpatient

6 prescription drugs or devices, or experimental

7 or investigational outpatient health care serv8 ices.

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

10 the term ‘limitation’ includes—

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

12 device, restricting the type of health care pro13 fessionals that may prescribe such drugs or de14 vices, utilization review provisions, and limits on

15 the volume of prescription drugs or devices that

16 may be obtained on the basis of a single con17 sultation with a professional; or

18 ‘‘(B) in the case of an outpatient contra19 ceptive service, restricting the type of health

20 care professionals that may provide such serv21 ices, utilization review provisions, requirements

22 relating to second opinions prior to the coverage

23 of such services, and requirements relating to

24 preauthorizations prior to the coverage of such

25 services.
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1 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The

2 imposition of the requirements of this section shall be

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

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

5 notice of such requirements under the plan, except that

6 the summary description required to be provided under the

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

8 modification shall be provided by not later than 60 days

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

10 requirements apply.

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

12 construed to preempt any provision of State law to the

13 extent that such State law establishes, implements, or con14 tinues in effect any standard or requirement that provides

15 protections for enrollees that are greater than the protec16 tions provided under this section.

17 ‘‘(f) DEFINITION.—In this section, the term ‘out18 patient contraceptive services’ means consultations, exami19 nations, procedures, and medical services, provided on an

20 outpatient basis and related to the use of contraceptive

21 methods (including natural family planning) to prevent an

22 unintended pregnancy.’’.

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

24 in section 1 of the Employee Retirement Income Security

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

2 new item:

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

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

4 this section shall apply with respect to plan years begin5 ning on or after January 1, 2002.

6 SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE

7 ACT RELATING TO THE GROUP MARKET.

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

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

10 300gg-4 et seq.) is amended by adding at the end the fol11 lowing new section:

12 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CON13 TRACEPTIVES.

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

15 health plan, and a health insurance issuer providing health

16 insurance coverage in connection with a group health plan,

17 may not—

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

19 contraceptive drugs or devices approved by the Food

20 and Drug Administration, or generic equivalents ap21 proved as substitutable by the Food and Drug Ad22 ministration, if such plan provides benefits for other

23 outpatient prescription drugs or devices; or

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

25 contraceptive services if such plan provides benefits
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1 for other outpatient services provided by a health

2 care professional (referred to in this section as ‘out3 patient 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 because of the individual’s or

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

11 that are covered in accordance with the requirements

12 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 covered individual contracep-
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1 tive drugs or devices, or contraceptive services, de2 scribed 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, except that such a deduct14 ible, coinsurance, or other cost-sharing or

15 limitation for any such drug may not be

16 greater than such a deductible, coinsur17 ance, or cost-sharing or limitation for any

18 outpatient prescription drug otherwise cov19 ered under the plan;

20 ‘‘(ii) benefits for contraceptive devices

21 under the plan, except that such a deduct22 ible, coinsurance, or other cost-sharing or

23 limitation for any such device may not be

24 greater than such a deductible, coinsur25 ance, or cost-sharing or limitation for any
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1 outpatient prescription device otherwise

2 covered under the plan; and

3 ‘‘(iii) benefits for outpatient contra4 ceptive services under the plan, except that

5 such a deductible, coinsurance, or other

6 cost-sharing or limitation for any such

7 service may not be greater than such a de8 ductible, coinsurance, or cost-sharing or

9 limitation for any outpatient health care

10 service otherwise covered under the plan;

11 and

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

13 a health insurance issuer providing health in14 surance coverage in connection with a group

15 health plan to cover experimental or investiga16 tional contraceptive drugs or devices, or experi17 mental or investigational contraceptive services,

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

19 that the plan or issuer provides coverage for

20 other experimental or investigational outpatient

21 prescription drugs or devices, or experimental

22 or investigational outpatient health care serv23 ices.

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

25 the term ‘limitation’ includes—
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1 ‘‘(A) in the case of a contraceptive drug or

2 device, restricting the type of health care pro3 fessionals that may prescribe such drugs or de4 vices, utilization review provisions, and limits on

5 the volume of prescription drugs or devices that

6 may be obtained on the basis of a single con7 sultation with a professional; or

8 ‘‘(B) in the case of an outpatient contra9 ceptive service, restricting the type of health

10 care professionals that may provide such serv11 ices, utilization review provisions, requirements

12 relating to second opinions prior to the coverage

13 of such services, and requirements relating to

14 preauthorizations prior to the coverage of such

15 services.

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

17 shall comply with the notice requirement under section

18 714(d) of the Employee Retirement Income Security Act

19 of 1974 with respect to the requirements of this section

20 as if such section applied to such plan.

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

22 construed to preempt any provision of State law to the

23 extent that such State law establishes, implements, or con24 tinues in effect any standard or requirement that provides
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1 protections for enrollees that are greater than the protec2 tions provided under this section.

3 ‘‘(f) DEFINITION.—In this section, the term ‘out4 patient contraceptive services’ means consultations, exami5 nations, procedures, and medical services, provided on an

6 outpatient basis and related to the use of contraceptive

7 methods (including natural family planning) to prevent an

8 unintended pregnancy.’’.

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

10 this section shall apply with respect to group health plans

11 for plan years beginning on or after January 1, 2002.

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

13 RELATING TO THE INDIVIDUAL MARKET.

14 (a) IN GENERAL.—Part B of title XXVII of the Pub15 lic Health Service Act (42 U.S.C. 300gg-41 et seq.) is

16 amended—

17 (1) by redesignating the first subpart 3 (relat18 ing to other requirements) as subpart 2; and

19 (2) by adding at the end of subpart 2 the fol20 lowing new section:

21 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CON22 TRACEPTIVES.

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

24 insurance coverage offered by a health insurance issuer

25 in the individual market in the same manner as they apply
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1 to health insurance coverage offered by a health insurance

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

3 or large group market.’’.

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

5 this section shall apply with respect to health insurance

6 coverage offered, sold, issued, renewed, in effect, or oper7 ated in the individual market on or after January 1, 2002.

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