REPORT TITLE:
Contraceptive Services


DESCRIPTION:
Requires all health insurers, mutual benefit societies, and
health maintenance organizations to cease excluding contraceptive
services and supplies from coverage by repealing the provision of
such coverage as an employer option; exempts certain employers
from providing coverage for contraceptive health care services
and supplies that are contrary to the employer's religious
tenets. (CD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        822
THE SENATE                              S.B. NO.           S.D. 2
TWENTIETH LEGISLATURE, 1999                                H.D. 2
STATE OF HAWAII                                            C.D. 1
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH INSURANCE.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  Chapter 431, Hawaii Revised Statutes, is amended
 
 2 by adding a new section to article 10A to be appropriately
 
 3 designated and to read as follows:
 
 4      "431:10A-     Contraceptive services; religious employers
 
 5 exemption.  (a)  A "religious employer" is an entity for which
 
 6 each of the following is true:
 
 7      (1)  The inculcation of religious values is the purpose of
 
 8           the entity;
 
 9      (2)  The entity primarily employs persons who share the
 
10           religious tenets of the entity;
 
11      (3)  The entity is not staffed by public employees; and
 
12      (4)  The entity is a nonprofit organization as defined under
 
13           section 501(c)(3) of the Internal Revenue Code of 1986,
 
14           as amended.
 
15 For the purpose of this definition, any educational, health care,
 
16 or other non-profit institution or organization owned or
 
17 controlled by the religious employer is included in this
 
18 exemption.
 
19      (b)  Notwithstanding any other provision of this chapter,
 

 
Page 2                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        C.D. 1

 
 1 any religious employer may request a health insurance plan
 
 2 without coverage for contraceptive services and supplies that are
 
 3 contrary to the religious employer's religious tenets.  If so
 
 4 requested, the health insurer, mutual benefit society, or health
 
 5 maintenance organization shall provide a health insurance plan
 
 6 without coverage for contraceptive services and supplies.  This
 
 7 subsection shall not be construed to deny an enrollee coverage
 
 8 of, and timely access to contraceptive services and supplies.
 
 9      (c)  Each religious employer that invokes the exemption
 
10 provided under this section shall:
 
11      (1)  Provide written notice to enrollees upon enrollment
 
12           with the plan, listing the contraceptive health care
 
13           services the employer refuses to cover for religious
 
14           reasons;
 
15      (2)  Provide written information describing how an enrollee
 
16           may directly access contraceptive services and supplies
 
17           in an expeditious manner; and
 
18      (3)  Ensure that enrollees who are refused contraceptive
 
19           services and supplies coverage under this section have
 
20           prompt access to the information developed under
 
21           paragraph (2).  Such notice shall appear, in not less
 
22           than twelve point type, in the policy, application, and
 
23           sales brochure for such policy.
 

 
Page 3                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        C.D. 1

 
 1      (d)  Nothing in this section shall be construed to exclude
 
 2 coverage for prescription contraceptive supplies ordered by a
 
 3 health care provider with prescriptive authority for reasons
 
 4 other than contraceptive purposes, such as decreasing the risk of
 
 5 ovarian cancer or eliminating symptoms of menopause, or for
 
 6 prescription contraception that is necessary to preserve the life
 
 7 or health of an enrollee.
 
 8      (e)  Health insurers, mutual benefit societies, and health
 
 9 maintenance organizations shall allow enrollees in a health plan
 
10 exempted under this section to directly purchase coverage of
 
11 contraceptive supplies and outpatient contraceptive services.
 
12 The enrollee's cost of purchasing such coverage shall not exceed
 
13 the enrollee's pro rata share of the price the group purchaser
 
14 would have paid for such coverage had the group plan not invoked
 
15 a religious exemption.
 
16      (f)  This section shall not be construed as to require a
 
17 health insurer, mutual benefit society, health maintenance
 
18 organization, health care facility, or health care provider to
 
19 provide any health care services without appropriate payment of
 
20 premium or fee.
 
21      (g)  For purposes of this section:
 
22      "Contraceptive services" means physician-delivered,
 
23 physician-supervised, physician assistant-delivered, nurse
 

 
Page 4                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        C.D. 1

 
 1 practitioner-delivered, certified nurse midwife-delivered, or
 
 2 nurse-delivered medical services intended to promote the
 
 3 effective use of contraceptive supplies or devices to prevent
 
 4 unwanted pregnancy.
 
 5      "Contraceptive supplies" means all Food and Drug
 
 6 Administration-approved contraceptive drugs or devices used to
 
 7 prevent unwanted pregnancy."
 
 8      SECTION 2.  Section 431:10A-116.6, Hawaii Revised Statutes,
 
 9 is amended to read as follows:
 
10      "[[]431:10A-116.6[]]  Contraceptive services[; options].
 
11 (a)  Notwithstanding any provision of law to the contrary, each
 
12 employer group health policy, contract, plan, or agreement issued
 
13 or renewed in this State on or after January 1, [1994, that
 
14 provides for payment of or reimbursement for pregnancy-related
 
15 services, shall provide as an employer option,] 2000, shall cease
 
16 to exclude contraceptive services or supplies for the subscriber
 
17 or any dependent of the subscriber who is covered by the
 
18 policy[.], subject to the exclusion under section 431:10A-  .
 
19      (b)  [Any] Except as provided in subsection (c), all
 
20 policies, contracts, plans, or agreements under subsection (a)
 
21 [above], that provide contraceptive services or supplies, or
 
22 prescription drug coverage, shall not exclude any [Food and Drug
 
23 Administration-approved prescriptive contraceptive drug or
 

 
Page 5                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        C.D. 1

 
 1 device,] prescription contraceptive supplies or impose any
 
 2 unusual copayment, charge, or waiting requirement for such [drug
 
 3 or device.] supplies.
 
 4      (c)  Coverage for oral contraceptives shall include at least
 
 5 one brand from the monophasic, multiphasic, and the progestin-
 
 6 only categories.  A member shall receive coverage for any other
 
 7 oral contraceptive only if:
 
 8      (1)  Use of brands covered has resulted in an adverse drug
 
 9           reaction; or
 
10      (2)  The member has not used the brands covered and, based
 
11           on the member's past medical history, the prescribing
 
12           health care provider believes that use of the brands
 
13           covered would result in an adverse reaction.
 
14      [(c)] (d)  For [the purpose] purposes of this section[,
 
15 "contraceptive services"]:
 
16      "Contraceptive services" means physician-delivered,
 
17 physician-supervised, physician assistant-delivered, nurse
 
18 practitioner-delivered, certified nurse midwife-delivered, or
 
19 nurse-delivered medical services intended to promote the
 
20 effective use of [prescription] contraceptive supplies or devices
 
21 to prevent unwanted pregnancy.
 
22      "Contraceptive supplies" means all Food and Drug
 
23 Administration-approved contraceptive drugs or devices used to
 

 
Page 6                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        C.D. 1

 
 1 prevent unwanted pregnancy.
 
 2      [(d)] (e)  Nothing in this section shall be construed to 
 
 3 extend the practice or privileges of any health care provider
 
 4 beyond that provided in the laws governing the provider's
 
 5 practice and privileges."
 
 6      SECTION 3.  Section 432:1-604.5, Hawaii Revised Statutes, is
 
 7 amended to read as follows:
 
 8      "[[]432:1-604.5[]]  Contraceptive services [; options].
 
 9 (a)  Notwithstanding any provision of law to the contrary, each
 
10 employer group health policy, contract, plan, or agreement issued
 
11 or renewed in this State on or after January 1, [1994, that
 
12 provides for payment of or reimbursement for pregnancy-related
 
13 services, shall provide as an employer option,] 2000, shall cease
 
14 to exclude contraceptive services or supplies, and contraceptive
 
15 prescription drug coverage for the subscriber or any dependent of
 
16 the subscriber who is covered by the policy[.], subject to the
 
17 exclusion under section 431:10A-   .
 
18      (b)  [Any] Except as provided in subsection (c), all
 
19 policies, contracts, plans, or agreements under subsection (a),
 
20 that provide contraceptive services or supplies, or prescription
 
21 drug coverage, shall not exclude any [Federal Drug
 
22 Administration-approved prescriptive contraceptive drug or
 
23 device,] prescription contraceptive supplies or impose any
 

 
Page 7                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        C.D. 1

 
 1 unusual copayment, charge, or waiting requirement for such drug
 
 2 or device.
 
 3      (c)  Coverage for contraceptives shall include at least one
 
 4 brand from the monophasic, multiphasic, and the progestin-only
 
 5 categories.  A member shall receive coverage for any other oral
 
 6 contraceptive only if:
 
 7      (1)  Use of brands covered has resulted in an adverse drug
 
 8           reaction; or
 
 9      (2)  The member has not used the brands covered and, based
 
10           on the member's past medical history, the prescribing
 
11           health care provider believes that use of the brands
 
12           covered would result in an adverse reaction.
 
13      [(c)] (d)  For [the purpose] purposes of this section[,
 
14 "contraceptive services"]:
 
15      "Contraceptive services" means physician-delivered,
 
16 physician-supervised, physician assistant-delivered, nurse
 
17 practitioner-delivered, certified nurse midwife-delivered, or
 
18 nurse-delivered medical services intended to promote the
 
19 effective use of [prescription] contraceptive supplies or devices
 
20 to prevent unwanted pregnancy.
 
21      "Contraceptive supplies" means all Food and Drug
 
22 Administration-approved contraceptive drugs or devices used to
 
23 prevent unwanted pregnancy."
 

 
Page 8                                                     822
                                     S.B. NO.           S.D. 2
                                                        H.D. 2
                                                        C.D. 1

 
 1      [(d)] (e)  Nothing in this section shall be construed to
 
 2 extend the practice or privileges of any health care provider
 
 3 beyond that provided in the laws governing the provider's
 
 4 practice and privileges."
 
 5      SECTION 4.  The insurance commissioner shall review the
 
 6 experience of employers in providing coverage of contraceptive
 
 7 services and supplies as part of their health insurance coverage
 
 8 for employees after the effective date of this Act to determine
 
 9 whether the cost of health insurance has increased as a result of
 
10 this Act.  The review shall include an assessment of the impact
 
11 of contraceptive coverage on reducing maternity costs, employee
 
12 turnover, and absenteeism costs around maternity and
 
13 family-related costs.  The insurance providers and business
 
14 organizations, including the Chamber of Commerce of Hawaii, are
 
15 requested to assist the insurance commissioner in obtaining the
 
16 necessary information from employers to effectuate the review.
 
17      The insurance commissioner shall submit a report of the
 
18 insurance commissioner's findings to the legislature no later
 
19 than twenty days prior to the convening of the regular session of
 
20 2001.
 
21      SECTION 5.  Statutory material to be repealed is bracketed.
 
22 New statutory material is underscored.
 
23      SECTION 6.  This Act shall take effect upon its approval.