Contraceptive Equity

Hawaii law requires health insurance plans to provide coverage for prescription contraception.

What is required?  Health insurance plans must provide coverage for contraceptive services and supplies, defined as all Food and Drug Administration-approved prescription contraceptive drugs or devices used to prevent unwanted pregnancy.  Insurers are required to provide coverage for at least one brand of oral contraceptive from the monophasic, multiphasic, and the progestin-only categories.  Additional types of oral contraceptives must be covered only if the use of covered brands has resulted, or could result, in an adverse drug reaction.

To which insurance plans does the law apply?  Employer group health insurance plans issued or renewed on or after January 1, 2000.

Does the law provide additional protections for women?  Yes.  Insurers may not impose unusual copayments, charges, or waiting periods for contraceptive drugs or devices.

Does the law contain a refusal clause, allowing certain employers and/or insurers to refuse to provide or pay for contraceptive coverage?  Yes.

To whom does the refusal clause apply?  Religious employers, or any educational, health care, or other nonprofit institution or organization owned or controlled by a religious employer, for whom contraceptive services and supplies are contrary to their religious tenets.

What does the refusal clause allow?  A religious employer, or any educational, health care, or other nonprofit institution or organization owned or controlled by a religious employer, may require issuers of its health insurance plans to exclude coverage of contraceptive services and supplies.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?  Yes.  The law exempts a "religious employer" defined as a non-profit organization that has the purpose of inculcation of religious values, primarily employs persons who share the religious tenets of the entity, and is not staffed by public employees, as well as any educational, health care, or other non-profit institution or organization owned or controlled by a religious employer.  This broad refusal clause inappropriately includes entities that operate in the public sphere.

Does the law require the refusing entity to notify the persons affected?  Yes.  An employer exercising a refusal clause must:  (1) provide written notice to enrollees upon enrollment in the health plan, listing the contraceptive health care services the employer refuses to cover for religious reasons; and (2) provide prompt written information describing how to access contraceptive services and supplies.

Are there circumstances under which a refusal clause may not be exercised?  Yes.  A refusal clause may not be used to exclude coverage for prescription contraceptive methods ordered for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating the symptoms of menopause, or for prescription contraception necessary to preserve the life or health of an enrollee.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause?  Yes.  Enrollees in an exempted health plan may purchase contraceptive coverage directly from the insurer, and the cost of purchasing such coverage shall not exceed the enrollee's pro rata share of the price the group purchaser would have paid had the employer not invoked the religious exemption.

Haw. Rev. Stat. Ann. §§ 431:10A-116.6 (Enacted 1993; Last Amended 2003), -116.7 (Enacted 1999, Last Amended 2003); 432:1-604.5 (Enacted 1999).