Insurance Coverage for Contraception
Insurance Coverage for Contraception
The federal health-reform law, the Affordable Care Act, requires all health plans to cover the full range of Food and Drug Administration (FDA)-approved contraceptive methods without additional cost. California built upon this provision and requires, under state law, health-insurance plans to cover each unique contraceptive product at no extra cost.
California law requires health-insurance plans that cover prescription medication to provide equitable coverage for contraception.
What is required? If a health-insurance plan provides coverage for outpatient prescription medication, it must provide coverage for a variety of Food and Drug Administration-approved prescription contraceptives, as designated by the insurer. If the insured's health-care provider determines that none of the methods designated by the insurer is medically appropriate, the insurer shall provide coverage for another FDA-approved prescription contraceptive prescribed by the insured's health-care provider.
To which insurance plans does the law apply? All health-care service plan contracts (except for specialized health-care service plan contracts) and certain disability insurance policies issued or renewed on or after January 1, 2000 that provide coverage for outpatient prescription medication.
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 for whom contraception is contrary to their religious tenets.
What does the refusal clause allow? A religious employer may require issuers of its health-insurance plans to exclude coverage for contraception.
Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? No. The law carefully defines the term "religious employer" as a nonprofit organization that has the purpose of inculcation of religious values and that primarily employs and serves persons who share the religious tenets of the entity. This definition appropriately covers religious entities but not broad-based 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 provide written notice of the exclusions to prospective employees.
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 contraception ordered for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for prescription contraception necessary to preserve the life or health of an insured.
Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause? No.
Has a court considered the constitutionality of this law? Yes. The California Supreme Court held that this law is constitutional under both federal and state constitutions. Catholic Charities of Sacramento, Inc. v. Superior Court, 85 P.3d 67 (Cal. 2004), cert. denied, 125 S. Ct. 53 (U.S. Oct. 4, 2004).
Cal. Health & Safety Code § 1367.25 (Enacted 1999, Last Amended 2002); Cal. Ins. Code § 10123.196 (Enacted 1999).
Improved Coverage for Contraception
California law builds upon federal law by strictly limiting a health plan's ability to impose cost-sharing on certain contraceptive products, such as the IUD, the contraceptive ring, or the contraceptive patch, by explicitly requiring that insurers cover each unique contraceptive product.
S. 1053, 2014 Leg., Reg. Sess. (Cal. 2014).