Bill > S2254

This bill mandates that all individual and group health insurance contracts, including those offered by health maintenance organizations (HMOs) and nonprofit hospital and medical service corporations, that are effective on or after January 1, 2027, must provide coverage for all Food and Drug Administration (FDA)-approved contraceptive drugs, devices, and other products, as well as voluntary sterilization procedures, patient education and counseling on contraception, and follow-up services. The bill also extends this coverage to spouses and dependents of the insured. Importantly, it specifies that if a therapeutic equivalent (a drug, device, or product with the same active ingredient and dosage form as the original FDA-approved product) exists, the contract must cover either the original or at least one equivalent, and if equivalents are unavailable or medically inadvisable, an alternate equivalent must be covered without any cost-sharing (like deductibles, copayments, or coinsurance). For over-the-counter contraceptives, plans cannot require a prescription and must provide point-of-sale coverage without cost-sharing or medical management restrictions. Furthermore, plans cannot limit the supply of FDA-approved contraception to less than a twelve-month supply and cannot impose utilization controls or require formal requests beyond a standard pharmacy claim. While an exemption exists for religious employers (defined as churches or qualified church-controlled organizations) to exclude contraceptive methods contrary to their religious tenets, this exemption does not apply to services provided for reasons other than contraception, such as treating ovarian cancer or menopause symptoms. Religious employers claiming this exemption must provide written notice to enrollees about the excluded services. The bill also includes provisions for Medicaid recipients to receive a twelve-month supply of contraceptives and establishes oversight by the health insurance commissioner, including stakeholder engagement, compliance reviews, and annual reporting.

Health and Social Services

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