Bill > SF188

Introduced Session

This bill relates to health insurance coverage for contraceptive devices, drugs, and services. The bill prohibits a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses (policy), and that provides coverage for prescription drugs, from excluding or restricting benefits for contraceptive drugs, contraceptive devices (contraceptives), or generic equivalents, if the policy provides benefits for other prescription drugs or devices. “Contraceptive device” and “contraceptive drug” are defined in the bill. The bill also prohibits a policy from excluding or restricting benefits for outpatient contraceptive services that are provided for the purpose of preventing conception if the policy provides benefits for other outpatient services provided by a health care professional (professional). A policy is prohibited from denying to an individual eligibility, or continued eligibility, to enroll in or renew coverage under the terms of the policy because of the individual’s use or potential use of contraceptives or outpatient contraceptive services; providing a monetary payment or rebate to a covered individual to encourage such individual to accept less than the minimum benefits provided for under the bill; penalizing, reducing, or limiting the reimbursement to a professional because such professional prescribes contraceptives or provides contraceptive services; and from providing incentives to a professional to induce such professional to withhold from a covered individual contraceptives or contraceptive services. The bill also prohibits a policy from imposing upon any covered individual any deductible, coinsurance, or copayment for benefits for contraceptives or contraceptive services. Under the bill, a policy that provides coverage for more than one therapeutically equivalent version of a contraceptive may impose cost-sharing requirements, provided that at least one therapeutically equivalent version of the contraceptive is available without cost-sharing. If a covered individual’s professional recommends a particular contraceptive based on a determination of medical need, a policy shall provide coverage for the recommended contraceptive without cost-sharing. The bill does not limit or otherwise discourage the use of generic equivalent drugs approved by the United States food and drug administration, whenever available and appropriate. When a brand-name drug is requested by a covered individual and a suitable generic equivalent is available and appropriate, the bill does not prohibit a third-party payor from requiring the covered individual to pay a deductible, coinsurance, or copayment, in addition to the difference of the cost of the brand-name drug less the maximum covered amount for a generic equivalent. The bill does not require a third-party payor under a policy to provide benefits for experimental or investigational contraceptives, or experimental or investigational contraceptive services, except to the extent that such policy provides coverage for other experimental or investigational outpatient prescription drugs or devices, or experimental or investigational outpatient health care services. A policy shall not impose any burdensome restrictions or delays on the coverage required by the bill and shall provide clear, written, and complete information on its internet site, and by mail upon request, about the contraceptive coverage included and excluded from the offered plans. A policy shall include a coverage provision. The policy shall provide that the policyholder may reject the coverage provision at the option of the policyholder. The bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state, on or after January 1, 2026, by the third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance not subject to the bill.

Committee Categories

Liz Bennett (D)*,  Tony Bisignano (D)*,  Matt Blake (D)*,  Molly Donahue (D)*,  Bill Dotzler (D)*,  Janet Petersen (D)*,  Herman Quirmbach (D)*,  Art Staed (D)*,  Thomas Townsend (D)*,  Sarah Trone Garriott (D)*,  Janice Weiner (D)*,  Cindy Winckler (D)*, 

Subcommittee: Driscoll, Trone Garriott, and Warme. S.J. 203. (on 02/05/2025)

Official Document