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Missouri

Refusal to Provide Medical Services

Missouri

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 provide abortion services.

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 abortion services.

An employer, college, university, or hospital may not discriminate against an individual because of a refusal to provide, assist in, refer for, promote, procure, or counsel a woman to choose abortion if 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 ABORTION REFUSAL CLAUSE

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

To whom does the refusal clause apply?  
Employers, plan providers, plan sponsors, health-care providers.

What does the refusal clause allow? 
No employer, health-plan provider, health-plan sponsor, health-care provider, or any other person or entity shall be compelled to provide coverage for, or be discriminated against or penalized for declining or refusing coverage for, abortion in a health plan if it is contrary to their religious beliefs or moral convictions. (Missouri already has a law that prohibits coverage of abortion in private plans and the exchange. See Insurance Prohibition for Abortion entry.)

Does the law require the refusing entity to notify the persons affected? 
No, only whether an optional rider for abortion coverage has been purchased for the plan.

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? 
Yes. Any health plan issued under the exception is required to provide clear and conspicuous written notice about optional riders for abortion.  However, nothing in the act requires an insurer to make such riders available and there is little evidence that insurers offer these products. Mo. Ann. Stat. §§191.724, 376.1199 (Enacted 2012).

INSURANCE COVERAGE FOR STERILIZATION REFUSAL CLAUSE


Missouri allows certain individuals or entities to refuse to provide coverage for sterilization.

To whom does the refusal clause apply?  
Employers, plan providers, plan sponsors, health-care providers.

What does the refusal clause allow? 
No employer, health-plan provider, health-plan sponsor, health-care provider, or any other person or entity shall be compelled to provide coverage for, or be discriminated against or penalized for declining or refusing coverage for, sterilization in a health plan if it is contrary to their religious beliefs or moral convictions.

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. §§191.724 (Enacted 2012).

PHARMACY MEDICATION STOCKING REFUSAL CLAUSE
Missouri allows pharmacies to refuse to stock any prescription or nonprescription drug or device.

To whom does the refusal clause apply?  Pharmacies.

What does the refusal clause allow?  A pharmacy may refuse to stock any prescription or nonprescription drug or device.

Does the law require the refusing individual or 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 prescription 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. S.B.126, 97th Gen. Assem., 1st Reg. Sess.(Mo. 2013).

Contraceptive Equity


Missouri law requires health-insurance plans that cover prescription medication to provide equitable coverage for contraception.

What is required? 
If a health-insurance plan provides pharmaceutical coverage, it must provide coverage for all Food and Drug Administration-approved prescription contraception.

To which insurance plans does the law apply? 
Health-benefit plans issued or renewed on or after January 1, 2002, except for certain limited benefit plans, that provide pharmaceutical coverage.

Does the law provide additional protections for women? 
Yes.  Such plans may not impose a deductible, coinsurance, or copayment greater than that imposed for any other covered medication on the plan's formulary.

Does the law contain a refusal clause, allowing certain employers and/or insurers to refuse to provide or pay for contraceptive coverage?  
No. On March 14, 2013, a federal court struck down the provision of the law that previously allowed for certain employers and plans to refuse to cover birth control if it was contrary to their religious beliefs or moral convictions.

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, Repealed and Re-Enacted 2012), Missouri Ins. Coal. V. Huff, No. 4:12CV02354, 2013 WL 1038756 (E.D.Mo. Mar. 14, 2013).


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