Insurance Coverage for Contraception
Delaware 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 Food and Drug Administration-approved prescription contraception and outpatient contraceptive services.
To which insurance plans does the law apply? All group and blanket health-insurance plans delivered or issued in the state by health insurers, health-service corporations, health-maintenance organizations, or any health services and facilities reimbursed programs for the state that provide coverage for outpatient prescription medication.
Does the law provide additional protections for women? Yes. Insurers shall impose the same terms and conditions as for other benefits and may not impose a copayment, coinsurance, or deductible for directly accessed gynecological services under this law that is different from that imposed for access to other health-care services.
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 conflicts with their bona fide religious beliefs.
What does the refusal clause allow? A religious employer may require issuers of its health-insurance plans to exclude coverage for insertion, removal, or medically necessary examinations associated with covered contraceptive drugs and devices if such coverage conflicts with the employer's bona fide religious beliefs and practices.
Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? Yes. By failing to define the term "religious employer," the law's refusal clause could include a wide range of entities that perform non-religious functions 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 its employees reasonable and timely notice of the exclusion.
Are there circumstances under which a refusal clause may not be exercised? No.
Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause? No.Del. Code Ann. tit. 18, § 3559 (Enacted 2000).