I
106TH CONGRESS
1ST SESSION
H. R. 2120
To require equitable coverage of prescription contraceptive drugs and devices,
and contraceptive services under health plans.
IN THE HOUSE OF REPRESENTATIVES
JUNE 10, 1999
Mr. GREENWOOD (for himself, Mrs. LOWEY, Mrs. JOHNSON of Connecticut,
Mr. WAXMAN, Mrs. KELLY, Mr. BROWN of Ohio, Mrs. ROUKEMA, Mr.
BOUCHER, Ms. PRYCE of Ohio, Mr. TOWNS, Mrs. MORELLA, Mr.
PALLONE, Mr. BILBRAY, Ms. PELOSI, Mr. HORN, Ms. DELAURO, Mr.
BOEHLERT, Ms. DEGETTE, Mr. LEACH, Ms. WOOLSEY, Mr. SHAYS, Mr.
MARKEY, Mr. COOK, Mr. CLAY, Mr. OSE, and Mr. GEORGE MILLER of
California) introduced the following bill; which was referred to the Com-
mittee on Education and the Workforce, and in addition to the Com-
mittee on 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.
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 1999’’.
(13) in 1998, Congress agreed to provide con-
traceptive coverage to the 2 million women of repro-
ductive age who are participating in the Federal
Employees Health Benefits Program, the largest
employer-sponsored health insurance plan in the
world; and
(14) eight in 10 privately insured adults sup-
port contraceptive coverage.
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 (29 U.S.C. 1185 et seq.) is amended by add-
ing at the end the following new section:
‘‘SEC. 714. 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.—
‘‘(1) IN
GENERAL.—Nothing in this section
shall be construed—
‘‘(A) as preventing a group health plan
and a health insurance issuer providing health
insurance coverage in connection with a group
health plan from imposing deductibles, coinsur-
ance, or other cost-sharing or limitations in re-
lation to—
‘‘(i) benefits for contraceptive drugs
under the plan, except that such a deduct-
ible, coinsurance, or other cost-sharing or
limitation for any such drug may not be
greater than such a deductible, coinsur-
ance, or cost-sharing or limitation for any
outpatient prescription drug otherwise cov-
ered under the plan;
‘‘(ii) benefits for contraceptive devices
under the plan, except that such a deduct-
ible, coinsurance, or other cost-sharing or
limitation for any such device may not be
greater than such a deductible, coinsur-
ance, or cost-sharing or limitation for any
outpatient prescription device otherwise
covered under the plan; and
‘‘(iii) benefits for outpatient contra-
ceptive services under the plan, except that
such a deductible, coinsurance, or other
cost-sharing or limitation for any such
service may not be greater than such a de-
ductible, coinsurance, or cost-sharing or
limitation for any outpatient health care
service otherwise covered under the plan;
and
‘‘(B) as requiring a group health plan and
a health insurance issuer providing health in-
surance coverage in connection with a group
health plan to cover experimental or investiga-
tional contraceptive drugs or devices, or experi-
mental or investigational contraceptive services,
described in subsection (a), except to the extent
that the plan or issuer provides coverage for
other experimental or investigational outpatient
prescription drugs or devices, or experimental
or investigational outpatient health care serv-
ices.
‘‘(2) LIMITATIONS.—As used in paragraph (1),
the term ‘limitation’ includes—
‘‘(A) in the case of a contraceptive drug or
device, restricting the type of health care pro-
fessionals that may prescribe such drugs or de-
vices, utilization review provisions, and limits on
the volume of prescription drugs or devices that
may be obtained on the basis of a single con-
sultation with a professional; or
‘‘(B) in the case of an outpatient contra-
ceptive service, restricting the type of health
care professionals that may provide such serv-
ices, utilization review provisions, requirements
relating to second opinions prior to the coverage
of such services, and requirements relating to
preauthorizations prior to the coverage of such
services.
‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The
imposition of the requirements of this section shall be
treated as a material modification in the terms of the plan
described in section 102(a)(1), for purposes of assuring
notice of such requirements under the plan, except that
the summary description required to be provided under the