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Insurance Coverage for Contraception

Maine 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 prescription medication or outpatient medical services, it must provide coverage for all Food and Drug Administration-approved prescription contraceptives or outpatient contraceptive services.

To which insurance plans does the law apply?  Individual and group health-insurance policies issues or renewed on or after March 1, 2000, except for certain limited benefit policies, that provide coverage for prescription medication or outpatient medical 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 contraceptive coverage conflicts with their bona fide religious beliefs and practices.

What does the refusal clause allow?  A religious employer may require that an insurer exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?  No.  The law appropriately defines the term "religious employer" as a tax-exempt church or association of churches or an elementary or secondary school controlled, operated, or principally supported by a church or an association of churches.  This definition is appropriately limited in scope, applying to 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 exclusion to insureds and prospective insureds.

Are there circumstances under which a refusal clause may not be exercised?  Yes.  A refusal clause may not be used to exclude coverage for contraceptives prescribed for reasons other than contraceptive purposes, or for prescription contraception necessary to preserve the life or health of the insured.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause?  No.

Me. Rev. Stat. Ann. tit. 24, § 2332-J (Enacted 1999); Me. Rev. Stat. Ann. tit. 24-A, §§ 2756, 2847-G, 4247 (Enacted 1999).

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