Bill Text: NY S00659 | 2019-2020 | General Assembly | Amended
Bill Title: Enacts the "comprehensive contraception coverage act" to provide insurance coverage for FDA-approved contraceptive drugs, devices and products.
Spectrum: Partisan Bill (Democrat 39-0)
Status: (Passed) 2019-04-12 - SIGNED CHAP.25 [S00659 Detail]
Download: New_York-2019-S00659-Amended.html
STATE OF NEW YORK ________________________________________________________________________ S. 659--A A. 585--A 2019-2020 Regular Sessions SENATE - ASSEMBLY (Prefiled) January 9, 2019 ___________ IN SENATE -- Introduced by Sens. SALAZAR, METZGER, ADDABBO, BAILEY, BENJAMIN, BIAGGI, BRESLIN, BROOKS, CARLUCCI, COMRIE, GAUGHRAN, GIANAR- IS, GOUNARDES, HARCKHAM, HOYLMAN, JACKSON, KAMINSKY, KAPLAN, KAVANAGH, KENNEDY, KRUEGER, LIU, MARTINEZ, MAY, MAYER, MONTGOMERY, MYRIE, PARK- ER, PERSAUD, RAMOS, RIVERA, SANDERS, SAVINO, SEPULVEDA, SERRANO, SKOUFIS, STAVISKY, STEWART-COUSINS, THOMAS -- read twice and ordered printed, and when printed to be committed to the Committee on Insur- ance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee IN ASSEMBLY -- Introduced by M. of A. CAHILL, SEAWRIGHT, HEASTIE, L. ROSENTHAL, GLICK, JAFFEE, SIMOTAS, GOTTFRIED, BARRON, BLAKE, BARRETT, MAGNARELLI, BRONSON, LAVINE, CARROLL, GALEF, OTIS, SIMON, HYNDMAN, RAMOS, D'URSO, PEOPLES-STOKES, PICHARDO, ORTIZ, WOERNER, BURKE, CRUZ, FALL, FRONTUS, GRIFFIN, JACOBSON, McMAHON, RAYNOR, ROMEO, REYES, SAYEGH -- Multi-Sponsored by -- M. of A. BRAUNSTEIN, BUCHWALD, COOK, EPSTEIN, LIFTON, LUPARDO, MOSLEY, ROZIC, THIELE, TITUS -- read once and referred to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law and the social services law, in relation to requiring health insurance policies to include coverage of all FDA-approved contraceptive drugs, devices, and products, as well as voluntary sterilization procedures, contraceptive education and counseling, and related follow up services and prohibiting a health insurance policy from imposing any cost-sharing requirements or other restrictions or delays with respect to this coverage The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD06618-04-9S. 659--A 2 A. 585--A 1 Section 1. This act shall be known and may be cited as the "comprehen- 2 sive contraception coverage act". 3 § 2. Paragraph 16 of subsection (l) of section 3221 of the insurance 4 law, as added by chapter 554 of the laws of 2002, is amended to read as 5 follows: 6 (16) (A) Every group or blanket policy [which provides coverage for7prescription drugs shall include coverage for the cost of contraceptive8drugs or devices approved by the federal food and drug administration or9generic equivalents approved as substitutes by such food and drug admin-10istration under the prescription of a health care provider legally11authorized to prescribe under title eight of the education law. The12coverage required by this section shall be included in policies and13certificates only through the addition of a rider.14(A)] that is issued, amended, renewed, effective or delivered on or 15 after January first, two thousand twenty, shall provide coverage for all 16 of the following services and contraceptive methods: 17 (1) All FDA-approved contraceptive drugs, devices, and other products. 18 This includes all FDA-approved over-the-counter contraceptive drugs, 19 devices, and products as prescribed or as otherwise authorized under 20 state or federal law. The following applies to this coverage: 21 (a) where the FDA has approved one or more therapeutic and pharmaceu- 22 tical equivalent, as defined by the FDA, versions of a contraceptive 23 drug, device, or product, a group or blanket policy is not required to 24 include all such therapeutic and pharmaceutical equivalent versions in 25 its formulary, so long as at least one is included and covered without 26 cost-sharing and in accordance with this paragraph; 27 (b) if the covered therapeutic and pharmaceutical equivalent versions 28 of a drug, device, or product are not available or are deemed medically 29 inadvisable a group or blanket policy shall provide coverage for an 30 alternate therapeutic and pharmaceutical equivalent version of the 31 contraceptive drug, device, or product without cost-sharing. If the 32 attending health care provider, in his or her reasonable professional 33 judgment, determines that the use of a non-covered therapeutic or phar- 34 maceutical equivalent of a drug, device, or product is warranted, the 35 health care provider's determination shall be final. The superintendent 36 shall promulgate regulations establishing a process, including time- 37 frames, for an insured, an insured's designee or an insured's health 38 care provider to request coverage of a non-covered contraceptive drug, 39 device, or product. Such regulations shall include a requirement that 40 insurers use an exception form that shall meet criteria established by 41 the superintendent; 42 (c) this coverage shall include emergency contraception without cost- 43 sharing when provided pursuant to a prescription or order under section 44 sixty-eight hundred thirty-one of the education law or when lawfully 45 provided over the counter; and 46 (d) this coverage must allow for the dispensing of up to twelve months 47 worth of a contraceptive at one time; 48 (2) Voluntary sterilization procedures; 49 (3) Patient education and counseling on contraception; and 50 (4) Follow-up services related to the drugs, devices, products, and 51 procedures covered under this paragraph, including, but not limited to, 52 management of side effects, counseling for continued adherence, and 53 device insertion and removal. 54 (B) A group or blanket policy subject to this paragraph shall not 55 impose a deductible, coinsurance, copayment, or any other cost-sharing 56 requirement on the coverage provided pursuant to this paragraph.S. 659--A 3 A. 585--A 1 (C) Except as otherwise authorized under this paragraph, a group or 2 blanket policy shall not impose any restrictions or delays on the cover- 3 age required under this paragraph. 4 (D) Benefits for an enrollee under this paragraph shall be the same 5 for an enrollee's covered spouse or domestic partner and covered 6 nonspouse dependents. 7 (E) Notwithstanding any other provision of this subsection, a reli- 8 gious employer may request a contract without coverage for federal food 9 and drug administration approved contraceptive methods that are contrary 10 to the religious employer's religious tenets. If so requested, such 11 contract shall be provided without coverage for contraceptive methods. 12 This paragraph shall not be construed to deny an enrollee coverage of, 13 and timely access to, contraceptive methods. 14 (1) For purposes of this subsection, a "religious employer" is an 15 entity for which each of the following is true: 16 (a) The inculcation of religious values is the purpose of the entity. 17 (b) The entity primarily employs persons who share the religious 18 tenets of the entity. 19 (c) The entity serves primarily persons who share the religious tenets 20 of the entity. 21 (d) The entity is a nonprofit organization as described in Section 22 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended. 23 (2) Every religious employer that invokes the exemption provided under 24 this paragraph shall provide written notice to prospective enrollees 25 prior to enrollment with the plan, listing the contraceptive health care 26 services the employer refuses to cover for religious reasons. 27 [(B) (i)] (F) (1) Where a group policyholder makes an election not to 28 purchase coverage for contraceptive drugs or devices in accordance with 29 subparagraph [(A)] (E) of this paragraph each certificateholder covered 30 under the policy issued to that group policyholder shall have the right 31 to directly purchase the rider required by this paragraph from the 32 insurer which issued the group policy at the prevailing small group 33 community rate for such rider whether or not the employee is part of a 34 small group. 35 [(ii)] (2) Where a group policyholder makes an election not to 36 purchase coverage for contraceptive drugs or devices in accordance with 37 subparagraph [(A)] (E) of this paragraph, the insurer that provides such 38 coverage shall provide written notice to certificateholders upon enroll- 39 ment with the insurer of their right to directly purchase a rider for 40 coverage for the cost of contraceptive drugs or devices. The notice 41 shall also advise the certificateholders of the additional premium for 42 such coverage. 43 [(C)] (G) Nothing in this paragraph shall be construed as authorizing 44 a group or blanket policy which provides coverage for prescription drugs 45 to exclude coverage for prescription drugs prescribed for reasons other 46 than contraceptive purposes. 47 [(D) Such coverage may be subject to reasonable annual deductibles and48coinsurance as may be deemed appropriate by the superintendent and as49are consistent with those established for other drugs or devices covered50under the policy.] 51 § 3. Subsection (cc) of section 4303 of the insurance law, as added by 52 chapter 554 of the laws of 2002, is amended to read as follows: 53 (cc) (1) Every contract [which provides coverage for prescription54drugs shall include coverage for the cost of contraceptive drugs or55devices approved by the federal food and drug administration or generic56equivalents approved as substitutes by such food and drug administrationS. 659--A 4 A. 585--A 1under the prescription of a health care provider legally authorized to2prescribe under title eight of the education law. The coverage required3by this section shall be included in contracts and certificates only4through the addition of a rider.5(1)] that is issued, amended, renewed, effective or delivered on or 6 after January first, two thousand twenty, shall provide coverage for all 7 of the following services and contraceptive methods: 8 (A) All FDA-approved contraceptive drugs, devices, and other products. 9 This includes all FDA-approved over-the-counter contraceptive drugs, 10 devices, and products as prescribed or as otherwise authorized under 11 state or federal law. The following applies to this coverage: 12 (i) where the FDA has approved one or more therapeutic and pharmaceu- 13 tical equivalent, as defined by the FDA, versions of a contraceptive 14 drug, device, or product, a contract is not required to include all such 15 therapeutic and pharmaceutical equivalent versions in its formulary, so 16 long as at least one is included and covered without cost-sharing and in 17 accordance with this subsection; 18 (ii) if the covered therapeutic and pharmaceutical equivalent versions 19 of a drug, device, or product are not available or are deemed medically 20 inadvisable a contract shall provide coverage for an alternate therapeu- 21 tic and pharmaceutical equivalent version of the contraceptive drug, 22 device, or product without cost-sharing. If the attending health care 23 provider, in his or her reasonable professional judgment, determines 24 that the use of a non-covered therapeutic or pharmaceutical equivalent 25 of a drug, device, or product is warranted, the health care provider's 26 determination shall be final. The superintendent shall promulgate regu- 27 lations establishing a process, including timeframes, for an insured, an 28 insured's designee or an insured's health care provider to request 29 coverage of a non-covered contraceptive drug, device, or product. Such 30 regulations shall include a requirement that insurers use an exception 31 form that shall meet criteria established by the superintendent; 32 (iii) this coverage shall include emergency contraception without 33 cost-sharing when provided pursuant to a prescription or order under 34 section sixty-eight hundred thirty-one of the education law or when 35 lawfully provided over the counter; and 36 (iv) this coverage must allow for the dispensing of up to twelve 37 months worth of a contraceptive at one time; 38 (B) Voluntary sterilization procedures; 39 (C) Patient education and counseling on contraception; and 40 (D) Follow-up services related to the drugs, devices, products, and 41 procedures covered under this subsection, including, but not limited to, 42 management of side effects, counseling for continued adherence, and 43 device insertion and removal. 44 (2) A contract subject to this subsection shall not impose a deduct- 45 ible, coinsurance, copayment, or any other cost-sharing requirement on 46 the coverage provided pursuant to this subsection. 47 (3) Except as otherwise authorized under this subsection, a contract 48 shall not impose any restrictions or delays on the coverage required 49 under this subsection. 50 (4) Benefits for an enrollee under this subsection shall be the same 51 for an enrollee's covered spouse or domestic partner and covered 52 nonspouse dependents. 53 (5) Notwithstanding any other provision of this subsection, a reli- 54 gious employer may request a contract without coverage for federal food 55 and drug administration approved contraceptive methods that are contrary 56 to the religious employer's religious tenets. If so requested, suchS. 659--A 5 A. 585--A 1 contract shall be provided without coverage for contraceptive methods. 2 This paragraph shall not be construed to deny an enrollee coverage of, 3 and timely access to, contraceptive methods. 4 (A) For purposes of this subsection, a "religious employer" is an 5 entity for which each of the following is true: 6 (i) The inculcation of religious values is the purpose of the entity. 7 (ii) The entity primarily employs persons who share the religious 8 tenets of the entity. 9 (iii) The entity serves primarily persons who share the religious 10 tenets of the entity. 11 (iv) The entity is a nonprofit organization as described in Section 12 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended. 13 (B) Every religious employer that invokes the exemption provided under 14 this paragraph shall provide written notice to prospective enrollees 15 prior to enrollment with the plan, listing the contraceptive health care 16 services the employer refuses to cover for religious reasons. 17 [(2)](6) (A) Where a group contractholder makes an election not to 18 purchase coverage for contraceptive drugs or devices in accordance with 19 paragraph [one] five of this subsection, each enrollee covered under the 20 contract issued to that group contractholder shall have the right to 21 directly purchase the rider required by this subsection from the insurer 22 or health maintenance organization which issued the group contract at 23 the prevailing small group community rate for such rider whether or not 24 the employee is part of a small group. 25 (B) Where a group contractholder makes an election not to purchase 26 coverage for contraceptive drugs or devices in accordance with paragraph 27 [one] five of this subsection, the insurer or health maintenance organ- 28 ization that provides such coverage shall provide written notice to 29 enrollees upon enrollment with the insurer or health maintenance organ- 30 ization of their right to directly purchase a rider for coverage for the 31 cost of contraceptive drugs or devices. The notice shall also advise the 32 enrollees of the additional premium for such coverage. 33 [(3)](7) Nothing in this subsection shall be construed as authorizing 34 a contract which provides coverage for prescription drugs to exclude 35 coverage for prescription drugs prescribed for reasons other than 36 contraceptive purposes. 37 [(4) Such coverage may be subject to reasonable annual deductibles and38coinsurance as may be deemed appropriate by the superintendent and as39are consistent with those established for other drugs or devices covered40under the policy.] 41 § 4. Subparagraph (E) of paragraph 17 of subsection (i) of section 42 3216 of the insurance law is amended by adding a new clause (v) to read 43 as follows: 44 (v) all FDA-approved contraceptive drugs, devices, and other products, 45 including all over-the-counter contraceptive drugs, devices, and 46 products as prescribed or as otherwise authorized under state or federal 47 law; voluntary sterilization procedures; patient education and coun- 48 seling on contraception; and follow-up services related to the drugs, 49 devices, products, and procedures covered under this clause, including, 50 but not limited to, management of side effects, counseling for continued 51 adherence, and device insertion and removal. Except as otherwise author- 52 ized under this clause, a contract shall not impose any restrictions or 53 delays on the coverage required under this clause. However, where the 54 FDA has approved one or more therapeutic and pharmaceutical equivalent, 55 as defined by the FDA, versions of a contraceptive drug, device, or 56 product, a contract is not required to include all such therapeutic andS. 659--A 6 A. 585--A 1 pharmaceutical equivalent versions in its formulary, so long as at least 2 one is included and covered without cost-sharing and in accordance with 3 this clause. If the covered therapeutic and pharmaceutical equivalent 4 versions of a drug, device, or product are not available or are deemed 5 medically inadvisable a contract shall provide coverage for an alternate 6 therapeutic and pharmaceutical equivalent version of the contraceptive 7 drug, device, or product without cost-sharing. (a) This coverage shall 8 include emergency contraception without cost sharing when provided 9 pursuant to a prescription, or order under section sixty-eight hundred 10 thirty-one of the education law or when lawfully provided over-the-coun- 11 ter. (b) If the attending health care provider, in his or her reason- 12 able professional judgment, determines that the use of a non-covered 13 therapeutic or pharmaceutical equivalent of a drug, device, or product 14 is warranted, the health care provider's determination shall be final. 15 The superintendent shall promulgate regulations establishing a process, 16 including timeframes, for an insured, an insured's designee or an 17 insured's health care provider to request coverage of a non-covered 18 contraceptive drug, device, or product. Such regulations shall include a 19 requirement that insurers use an exception form that shall meet criteria 20 established by the superintendent. (c) This coverage must allow for the 21 dispensing of up to twelve months worth of a contraceptive at one time. 22 § 5. Paragraph (d) of subdivision 3 of section 365-a of the social 23 services law, as amended by chapter 909 of the laws of 1974 and as 24 relettered by chapter 82 of the laws of 1995, is amended to read as 25 follows: 26 (d) family planning services and twelve months of supplies for eligi- 27 ble persons of childbearing age, including children under twenty-one 28 years of age who can be considered sexually active, who desire such 29 services and supplies, in accordance with the requirements of federal 30 law and regulations and the regulations of the department. Coverage of 31 prescription contraceptives shall include a twelve-month supply that may 32 be dispensed at one time or up to twelve times within one year from the 33 date of the prescription. No person shall be compelled or coerced to 34 accept such services or supplies. 35 § 6. This act shall take effect January 1, 2020.
