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 
following 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 or coverage provides bene-
fits for other outpatient prescription drugs or de-
vices; or 
‘‘(2) exclude or restrict benefits for outpatient 
contraceptive services if such plan or coverage pro-
vides benefits for other outpatient services provided 
by a health care professional (referred to in this sec-
tion as ‘outpatient health care services’). 
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‘‘(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 or coverage because of the in-
dividual’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.—
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‘‘(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 or coverage, except that 
such a deductible, coinsurance, or other 
cost-sharing or limitation for any such 
drug shall be consistent with those imposed 
for any outpatient prescription drug other-
wise covered under the plan or coverage; 
‘‘(ii) benefits for contraceptive devices 
under the plan or coverage, except that 
such a deductible, coinsurance, or other 
cost-sharing or limitation for any such de-
vice shall be consistent with those imposed 
for any outpatient prescription device oth-
erwise covered under the plan or coverage; 
and 
‘‘(iii) benefits for outpatient contra-
ceptive services under the plan or coverage, 
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except that such a deductible, coinsurance, 
or other cost-sharing or limitation for any 
such service shall be consistent with those 
imposed for any outpatient health care 
service otherwise covered under the plan or 
coverage; 
‘‘(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; or 
‘‘(C) as modifying, diminishing, or limiting 
the rights and protections of an individual 
under any other Federal law. 
‘‘(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-
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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.—A group health plan under this part 
shall comply with the notice requirement under section 
714(d) of the Employee Retirement Income Security Act 
of 1974 with respect to the requirements of this section 
as if such section applied to such plan. 
‘‘(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 
coverage or protections for enrollees that are greater than 
the coverage or protections provided under this section. 
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‘‘(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, 2005. 
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 
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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, 2005.
Æ
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