[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4651 Introduced in House (IH)]







109th CONGRESS
  1st Session
                                H. R. 4651

 To require equitable coverage of prescription contraceptive drugs and 
        devices, and contraceptive services under health plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 22, 2005

  Mrs. Lowey introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
Education and the Workforce, 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 Representatives 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 2005''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) each year, 3,000,000 pregnancies, or one half of all 
        pregnancies, in this country are unintended;
            (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 effective: 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'';
            (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 individual 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 indemnity plans and 
        preferred provider organizations, 20 percent of point-of-
        service networks, and 7 percent of health maintenance 
        organizations cover no contraceptive methods other than 
        sterilization;
            (10) women of reproductive age spend 68 percent 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 contraceptives 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 the proportion of all 
        health insurance policies that cover contraceptive services and 
        supplies'';
            (13) in 1998, Congress agreed to provide contraceptive 
        coverage to the 2,000,000 women of reproductive 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 Management 
        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 support 
        contraceptive coverage;
            (15) contraceptive coverage saves employers money: the 
        Washington Business Group on Health estimates that not covering 
        contraceptives in employee health plans costs employers 15 to 
        17 percent more than providing such coverage; and
            (16) Healthy People 2010, published by the Office of the 
        Surgeon General, has established a 10-year national public 
        health goal to increase the percentage of health plans that 
        cover contraceptives.

SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME 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 adding at the end the following new section:

``SEC. 714. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.

    ``(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 approved as 
        substitutable by the Food and Drug Administration, if such plan 
        or coverage provides benefits for other outpatient prescription 
        drugs or devices; or
            ``(2) exclude or restrict benefits for outpatient 
        contraceptive services if such plan or coverage provides 
        benefits for other outpatient services provided by a health 
        care professional (referred to in this section as `outpatient 
        health care services').
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan or coverage 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 professional to 
        withhold from a covered individual contraceptive 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, coinsurance, or other cost-
                sharing or limitations in relation 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 otherwise 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 device shall be 
                        consistent with those imposed for any 
                        outpatient prescription device otherwise 
                        covered under the plan or coverage; and
                            ``(iii) benefits for outpatient 
                        contraceptive services under the plan or 
                        coverage, 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 insurance coverage in 
                connection with a group health plan to cover 
                experimental or investigational contraceptive drugs or 
                devices, or experimental 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 
                services; 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 
                professionals that may prescribe such drugs or devices, 
                utilization review provisions, and limits on the volume 
                of prescription drugs or devices that may be obtained 
                on the basis of a single consultation with a 
                professional; or
                    ``(B) in the case of an outpatient contraceptive 
                service, restricting the type of health care 
                professionals that may provide such services, 
                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 continues 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 `outpatient 
contraceptive services' means consultations, examinations, 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 inserting 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 beginning on or after January 1, 2007.

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 CONTRACEPTIVES.

    ``(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 approved as 
        substitutable by the Food and Drug Administration, if such plan 
        or coverage provides benefits for other outpatient prescription 
        drugs or devices; or
            ``(2) exclude or restrict benefits for outpatient 
        contraceptive services if such plan or coverage provides 
        benefits for other outpatient services provided by a health 
        care professional (referred to in this section as `outpatient 
        health care services').
    ``(b) Prohibitions.--A group health plan, and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan or coverage 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 professional to 
        withhold from covered individual contraceptive 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, coinsurance, or other cost-
                sharing or limitations in relation 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 otherwise 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 device shall be 
                        consistent with those imposed for any 
                        outpatient prescription device otherwise 
                        covered under the plan or coverage; and
                            ``(iii) benefits for outpatient 
                        contraceptive services under the plan or 
                        coverage, 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 insurance coverage in 
                connection with a group health plan to cover 
                experimental or investigational contraceptive drugs or 
                devices, or experimental 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 
                services; 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 
                professionals that may prescribe such drugs or devices, 
                utilization review provisions, and limits on the volume 
                of prescription drugs or devices that may be obtained 
                on the basis of a single consultation with a 
                professional; or
                    ``(B) in the case of an outpatient contraceptive 
                service, restricting the type of health care 
                professionals that may provide such services, 
                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 continues 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.
    ``(f) Definition.--In this section, the term `outpatient 
contraceptive services' means consultations, examinations, 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, 2007.

SEC. 5. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE 
              INDIVIDUAL MARKET.

    (a) In General.--Part B of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg-41 et seq.) is amended--
            (1) by redesignating the first subpart 3 (relating to other 
        requirements) as subpart 2; and
            (2) by adding at the end of subpart 2 the following new 
        section:

``SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CONTRACEPTIVES.

    ``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 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 operated in the individual market on or after 
January 1, 2007.
                                 <all>