Insurance Coverage for Contraception
Illinois 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 or devices and outpatient services, it must provide coverage for all Food and Drug Administration-approved outpatient contraception and outpatient contraceptive services.
To which insurance plans does the law apply? Individual and group health-insurance policies, including health maintenance organization policies, issued or renewed after January 1, 2004 that provide coverage for outpatient prescription medication or devices and outpatient services.
Does the law provide additional protections for women? Yes. An insurer may not impose any deductible, coinsurance, waiting period, or other cost-sharing or limitation that is greater than that required for any outpatient service or prescription drug or device otherwise covered by the policy.
Does the law contain a refusal clause, allowing certain employers and/or insurers to refuse to provide or pay for contraceptive coverage? Yes.
What does the refusal clause allow? An insurance company may refuse to cover family-planning services that violate their religious beliefs.
Is the refusal clause overbroad, jeopardizing insurance coverage for contraception for women? Yes. The law permits insurers to refuse to provide contraceptive coverage. This broad refusal clause inappropriately includes insurers that operate in the public sphere.
Does the law require the refusing entity to notify the person affected? No.
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 insurer exercises a refusal clause? No.
215 Ill. Comp. Stat. Ann. 5/356z.4 (Enacted 2003); 215 Ill. Comp. Stat. Ann. 125/5-3 (Enacted 2003). 745 Ill. Comp. Stat. Ann. 70/13 (Enacted 1998).