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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?  Yes.

To whom does the refusal clause apply?  Employers for whom use or provision of contraception conflicts with their moral, ethical, or religious beliefs or tenets, as well as insurers owned, operated, or substantially controlled by an entity operated according to moral, ethical, or religious tenets that are contrary to the use or provision of contraceptives.

What does the refusal clause allow?  An employer or insurer exercising a moral, ethical, or religious refusal may require or issue plans that exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?  Yes.  By applying to employers and insurers with any moral, ethical, or religious belief or tenet that conflicts with use or provision of contraceptives, and by failing to define any of the relevant terminology, the law's refusal clause is tremendously overbroad, inappropriately including a wide range of entities that perform non-religious functions in the public sphere.

Does the law require that the persons affected by the refusal be notified?  Yes.  A health-insurance plan must provide clear and conspicuous written notice on the enrollment form or any accompanying materials indicating:  (1) whether the plan covers contraceptives; (2) that an enrollee may obtain a policy excluding contraceptive coverage if it conflicts with his or her moral, ethical, or religious beliefs; and (3) that an enrollee who is a member of a plan that does not cover contraceptives has the right to purchase such coverage.

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 by a health-care provider for reasons other than contraception.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer and/or insurer exercises a refusal clause?  Yes, if an employer purchases a health-benefit plan that excludes contraceptive coverage because such coverage is contrary to its moral, ethical, or religious beliefs, an insurer must allow employees to purchase a plan that includes contraceptive coverage (provided such coverage is not contrary to the insurer's moral, ethical, or religious beliefs.)

May an individual obtain a health-insurance policy that excludes contraceptive coverage?  Yes.  An individual who is a member of a group health-insurance plan and who states that the use or provision of contraceptives is contrary to his or her moral, ethical, or religious beliefs may obtain an individual plan that excludes coverage for contraception.

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).

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