I 
110TH CONGRESS 
1ST SESSION H. R. 2412 
To require equitable coverage of prescription contraceptive drugs and devices 
and contraceptive services under health plans. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 21, 2007 
Mrs. LOWEY introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Education and Labor, 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 2007’’. 
SEC. 2. FINDINGS. 
Congress finds that— 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
(1) each year, 3,000,000 pregnancies, or one 
half of all pregnancies, in this country are unin-
tended; 
(2) contraceptives and contraceptive services 
are part of basic health care, allowing families to 
both adequately space desired pregnancies and avoid 
unintended pregnancy, and should be provided under 
the same terms and conditions as other basic health 
care; 
(3) studies show that contraceptives are cost ef-
fective: it is estimated that for every $1 of public 
funds invested in family planning, $3 is saved in 
medicaid costs from pregnancy-related healthcare 
and medical care for newborns; 
(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’’; 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
(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 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
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 2,000,000 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, in 2001, the Office of Personnel Man-
agement reported that it did not raise premiums as 
a result of such coverage because there was ‘‘no cost 
increase due to contraceptive coverage’’; 
(14) eight in 10 privately insured adults sup-
port contraceptive coverage; 
(15) contraceptive coverage saves employers 
money: the Washington Business Group on Health 
estimates that not covering contraceptives in em-
ployee health plans costs employers 15 to 17 percent 
more than providing such coverage; and 
(16) Healthy People 2010, published by the Of-
fice of the Surgeon General, has established a 10- 
year national public health goal to increase the per-
centage of health plans that cover contraceptives. 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
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 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’). 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
‘‘(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 a covered individual contra-
ceptive drugs or devices, or contraceptive services, 
described in subsection (a). 
‘‘(c) RULES OF CONSTRUCTION.— 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
‘‘(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, 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
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-
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
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 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
extent that such State law establishes, implements, or con-
tinues in effect any standard or requirement that provides 
coverage or protections for participants or beneficiaries 
that are greater than the coverage or protections 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: 
‘‘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, 2009. 
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: 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
‘‘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’). 
‘‘(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 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS
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— 
VerDate Aug 31 2005 
00:26 May 24, 2007
Jkt 059200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H2412.IH
H2412
mstockstill on PROD1PC66 with BILLS