‘‘(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 such Act, as amended by section 603 of
the Newborns’ and Mothers’ Health Protection Act of
1996 and section 702 of the Mental Health Parity Act
of 1996, is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 713. 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, 1998.
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 (as added by sec-
tion 604(a) of the Newborns’ and Mothers’ Health Protec-
tion Act of 1996 and amended by section 703(a) of the
Mental Health Parity Act of 1996) is further amended
by adding at the end the following new section:
‘‘SEC. 2706. 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.—A group health plan under this part
shall comply with the notice requirement under section
713(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
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, 1998.
SEC. 5. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT
RELATING TO THE INDIVIDUAL MARKET.
(a) IN GENERAL.—Subpart 3 of part B of title
XXVII of the Public Health Service Act (as added by sec-
tion 605(a) of the Newborn’s and Mother’s Health Protec-
tion Act of 1996) is amended by adding at the end the
following new section:
‘‘SEC. 2752. STANDARDS RELATING TO BENEFITS FOR CON-
TRACEPTIVES.
‘‘The provisions of section 2706 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, 1998.
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