Refusal to Provide Medical Services

ABORTION REFUSAL CLAUSE

Missouri allows certain individuals or entities to refuse to provide abortion services.

To whom does the refusal clause apply?  Individuals, physicians, nurses, midwives, or hospitals.

What does the refusal clause allow?  No physician, nurse, midwife, or hospital may be required to admit or treat a woman for the purpose of an abortion if admission or treatment is contrary to moral, ethical, or religious beliefs or established policy.  Refusal to treat or admit may not be a basis for a cause of action.

No person or institution may be denied a public benefit or discriminated against in employment on the basis of refusal to advise, assist in, or perform an abortion.

No applicant, student, teacher, or school employee who objects in writing on grounds of conscience or belief may be required to pay any school fees that would in whole or part fund an abortion.

An employer, college, university, or hospital may not discriminate against an individual because of a refusal to perform, assist in, refer for, promote, procure, or counsel a woman to have an abortion not necessary to preserve her life, except where an employer demonstrates an inability to reasonably accommodate the refusal to participate without undue hardship or where participation in abortion is a bona fide occupational qualification reasonably necessary to normal operations.

An individual injured by prohibited discrimination may bring a civil action for treble damages, costs, and attorneys' fees.

Does the law require the refusing entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Mo. Ann. Stat. §§ 188.100 to .120 (Enacted 1986), 197.032 (Enacted 1973).

INSURANCE COVERAGE FOR CONTRACEPTION REFUSAL CLAUSE

Although Missouri law requires health insurance plans that cover prescription drugs to provide equitable coverage for contraception, certain employers and/or insurers may require that their plans exclude coverage for contraception.

To whom does the refusal clause apply?  Employers for whom use or provision of contraception conflicts with their moral, ethical, or religious beliefs or tenets, as well as insurers owned, operated, or substantially controlled by an entity operated according to moral, ethical, or religious tenets that are contrary to the use or provision of contraceptives.

What does the refusal clause allow?  An employer or insurer exercising a moral, ethical, or religious refusal may require or issue plans that exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?  Yes.  By applying to employers and insurers with any moral, ethical, or religious belief or tenet that conflicts with use or provision of contraceptives, and by failing to define any of the relevant terminology, the law's refusal clause is tremendously overbroad, inappropriately including a wide range of entities that perform non-religious functions in the public sphere.

Does the law require that the persons affected by the refusal be notified?  Yes.  A health insurance plan must provide clear and conspicuous written notice on the enrollment form or any accompanying materials indicating: (1) whether the plan covers contraceptives; (2) that an enrollee may obtain a policy excluding contraceptive coverage if it conflicts with his or her moral, ethical, or religious beliefs; and (3) that an enrollee who is a member of a plan that does not cover contraceptives has the right to purchase such coverage.

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 drugs or devices ordered by a health care provider for reasons other than contraception.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer and/or insurer exercises a refusal clause?  Yes, in some circumstances.  Unless exercising a refusal clause, an insurer must allow enrollees in a health insurance plan that excludes coverage for contraception to purchase a health benefit plan that includes coverage for contraception.

May an individual obtain a health insurance policy that excludes contraceptive coverage?  Yes.  An individual who is a member of a group health insurance plan and who states that the use or provision of contraceptives is contrary to his or her moral, ethical, or religious beliefs may require an individual plan that excludes coverage for contraception.

Does the law offer any other additional protections?  Yes.  An insurer may not disclose the names of enrollees who either refuse or purchase plans that cover contraception.  Enrollees shall not be discriminated against because they refused or purchased plans providing contraceptive coverage.

Mo. Ann. Stat. § 376.1199 (Enacted 2001).