I
105TH CONGRESS
1ST SESSION
H. R. 2174
To require equitable coverage of prescription contraceptive drugs and devices,
and contraceptive services under health plans.
IN THE HOUSE OF REPRESENTATIVES
JULY 16, 1997
Mr. GREENWOOD (for himself, Ms. MOLINARI, Mrs. LOWEY, Mr. WAXMAN,
Mr. HORN, Mr. SHAYS, Mr. BILBRAY, Mrs. MORELLA, Ms. WOOLSEY,
Mr. COOK, and Mrs. KENNELLY of Connecticut) introduced the following
bill; which was referred to the Committee on Education and the
Workforce, and in addition to the Committee on Commerce, for a period
to be subsequently determined by the Speaker, in each case for consider-
ation 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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Equity in Prescription
Insurance and Contraceptive Coverage Act of 1997’’.
SEC. 2. FINDINGS.
Congress finds that—
(1) each year, approximately 3,600,000 preg-
nancies, or nearly 60 percent of all pregnancies, in
this country are unintended;
(2) contraceptive services are part of basic
health care, allowing families to both adequately
space desired pregnancies and avoid unintended
pregnancy;
(3) studies show that contraceptives are cost-ef-
fective: for every $1 of public funds invested in fam-
ily planning, $4 to $14 of public funds is saved in
pregnancy and health care-related costs;
(4) by reducing rates of unintended pregnancy,
contraceptives help reduce the need for abortion;
(5) unintended pregnancies lead to higher rates
of infant mortality, low-birth weight, and maternal
morbidity, and threaten the economic viability of
families;
(6) the National Commission to Prevent Infant
Mortality determined that ‘‘infant mortality could be
reduced by 10 percent if all women not desiring
pregnancy used contraception’’;
(7) most women in the United States, including
two-thirds of women of childbearing age, rely on
some form of private employment-related insurance
(through either their own employer or a family mem-
ber’s employer) to defray their medical expenses;
(8) the vast majority of private insurers cover
prescription drugs, but many exclude coverage for
prescription contraceptives;
(9) private insurance provides extremely limited
coverage of contraceptives: half of traditional indem-
nity plans and preferred provider organizations, 20
percent of point-of-service networks, and 7 percent
of health maintenance organizations cover no contra-
ceptive methods other than sterilization;
(10) women of reproductive age spend 68 per-
cent more than men on out-of-pocket health care
costs, with contraceptives and reproductive health
care services accounting for much of the difference;
(11) the lack of contraceptive coverage in health
insurance places many effective forms of contracep-
tives beyond the financial reach of many women,
leading to unintended pregnancies; and
(12) the Institute of Medicine Committee on
Unintended Pregnancy recently recommended that
‘‘financial barriers to contraception be reduced by
increasing the proportion of all health insurance
policies that cover contraceptive services and sup-
plies’’.
SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN-
COME SECURITY ACT OF 1974.
(a) IN GENERAL.—Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security
Act of 1974 (as added by section 603(a) of the Newborns’
and Mothers’ Health Protection Act of 1996 and amended
by section 702(a) of the Mental Health Parity Act of
1996) is further amended by adding at the end the follow-
ing new section:
‘‘SEC. 713. STANDARDS RELATING TO BENEFITS FOR CON-
TRACEPTIVES.
‘‘(a) REQUIREMENTS
FOR
COVERAGE.—A group
health plan, and a health insurance issuer providing health
insurance coverage in connection with a group health plan,
may not—
‘‘(1) exclude or restrict benefits for prescription
contraceptive drugs or devices approved by the Food
and Drug Administration, or generic equivalents ap-
proved as substitutable by the Food and Drug Ad-
ministration, if such plan provides benefits for other
outpatient prescription drugs or devices; or
‘‘(2) exclude or restrict benefits for outpatient
contraceptive services if such plan provides benefits
for other outpatient services provided by a health
care professional (referred to in this section as ‘out-
patient health care services’).
‘‘(b) PROHIBITIONS.—A group health plan, and a
health insurance issuer providing health insurance cov-
erage in connection with a group health plan, may not—
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under
the terms of the plan because of the individual’s or
enrollee’s use or potential use of items or services
that are covered in accordance with the requirements
of this section;
‘‘(2) provide monetary payments or rebates to
a covered individual to encourage such individual to
accept less than the minimum protections available
under this section;
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of a health care professional because
such professional prescribed contraceptive drugs or
devices, or provided contraceptive services, described
in subsection (a), in accordance with this section; or
‘‘(4) provide incentives (monetary or otherwise)
to a health care professional to induce such profes-
sional to withhold from a covered individual contra-
ceptive drugs or devices, or contraceptive services,
described in subsection (a).
‘‘(c) RULES OF CONSTRUCTION.—