Insurance Coverage for Contraception
New Jersey 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, it must provide coverage for Food and Drug Administration-approved prescription contraception.
To which insurance plans does the law apply? Individual, group and certain small employer health-insurance policies, health, hospital, or medical service contracts, health maintenance organizations (HMOs) and prepaid prescription service organizations that provide coverage for prescription medication.
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 is contrary to their bona fide religious beliefs and practices.
What does the refusal clause allow? A religious employer may require issuers of its health-insurance plans to exclude coverage for contraception, such as to preserve the life or health of an enrollee.
Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? No. The law narrowly 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 narrow 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 to prospective enrollees.
Are there circumstances under which a refusal clause may not be exercised? Yes. A refusal clause may not be used to exclude overage for prescription medication prescribed for reasons other than contraception.
Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause? No.
N.J. Stat. Ann. C.17:48-6ee, C.17:48A-7bb, C.17:48E-35.29, C.17B:27-46.1ee, C.17B:26-2.1y, C.26:2J-4.30, C.17B:27A-19.15, C.17:48F-13.2, C.52:14-17.29j, 17B:27A-7.12 (Enacted 2006).