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. BAR-
RETT, 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 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 2001’’.
SEC. 2. FINDINGS.
Congress finds that—
(1) each year, 3,000,000 pregnancies, or one
half of all pregnancies, in this country are unin-
tended;
(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
three-quarters of women of childbearing age, rely on
some form of private insurance (through their own
employer, a family member’s employer, or the indi-
vidual market) 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;
(12) the Institute of Medicine Committee on
Unintended Pregnancy recommended that ‘‘financial
barriers to contraception be reduced by increasing
the proportion of all health insurance policies that
cover contraceptive services and supplies’’;
(13) in 1998, Congress agreed to provide con-
traceptive coverage to the 1,200,000 women of re-
productive 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
last sentence of section 104(b)(1) with respect to such
modification shall be provided by not later than 60 days
after the first day of the first plan year in which such
requirements apply.
‘‘(e) PREEMPTION.—Nothing in this section shall be
construed to preempt any provision of State law to the
extent that such State law establishes, implements, or con-
tinues in effect any standard or requirement that provides
protections for enrollees that are greater than the protec-
tions provided under this section.
‘‘(f) DEFINITION.—In this section, the term ‘out-
patient contraceptive services’ means consultations, exami-
nations, procedures, and medical services, provided on an
outpatient basis and related to the use of contraceptive
methods (including natural family planning) to prevent an
unintended pregnancy.’’.
(b) CLERICAL AMENDMENT.—The table of contents
in section 1 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1001 note) is amended by insert-
ing after the item relating to section 713 the following
new item:
‘‘Sec. 714. Standards relating to benefits for contraceptives.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to plan years begin-
ning on or after January 1, 2002.
SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
ACT RELATING TO THE GROUP MARKET.
(a) IN GENERAL.—Subpart 2 of part A of title
XXVII of the Public Health Service Act (42 U.S.C.
300gg-4 et seq.) is amended by adding at the end the fol-
lowing new section:
‘‘SEC. 2707. 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 covered individual contracep-
tive drugs or devices, or contraceptive services, de-
scribed 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—
protections for enrollees that are greater than the protec-
tions provided under this section.
‘‘(f) DEFINITION.—In this section, the term ‘out-
patient contraceptive services’ means consultations, exami-
nations, procedures, and medical services, provided on an
outpatient basis and related to the use of contraceptive
methods (including natural family planning) to prevent an
unintended pregnancy.’’.
(b) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to group health plans
for plan years beginning on or after January 1, 2002.
SEC. 5. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT
RELATING TO THE INDIVIDUAL MARKET.
(a) IN GENERAL.—Part B of title XXVII of the Pub-
lic Health Service Act (42 U.S.C. 300gg-41 et seq.) is
amended—
(1) by redesignating the first subpart 3 (relat-
ing to other requirements) as subpart 2; and
(2) by adding at the end of subpart 2 the fol-
lowing new section:
‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CON-
TRACEPTIVES.
‘‘The provisions of section 2707 shall apply to health
insurance coverage offered by a health insurance issuer
in the individual market in the same manner as they apply
to health insurance coverage offered by a health insurance
issuer in connection with a group health plan in the small
or large group market.’’.
(b) EFFECTIVE DATE.—The amendment made by
this section shall apply with respect to health insurance
coverage offered, sold, issued, renewed, in effect, or oper-
ated in the individual market on or after January 1, 2002.
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