Insurance Coverage for Contraception
North Carolina 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, devices or outpatient services, it must provide coverage for Food and Drug Administration-approved prescription contraception, except for the emergency contraceptive Preven or any equivalent product.
To which insurance plans does the law apply? Insurers providing health-benefit plans that are issued or delivered on or after January 1, 2000 that provide coverage for prescription medication, devices or outpatient services.
Does the law provide additional protections for women? Yes. Such plans may not impose different deductibles, coinsurance, or limitations for contraceptive medication, devices, or services from those imposed on other medications, devices, or outpatient services. In addition, plans may not: (1) deny eligibility solely for the purpose of avoiding the contraceptive-coverage requirement; (2) provide monetary payments to encourage an insured to accept less than the minimum coverage required by this section; (3) penalize or otherwise limit the reimbursement of a provider because he or she provided contraception; or (4) provide incentives to encourage providers to withhold contraception.
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 prescription contraceptive drugs or devices are contrary to their religious tenets.
What does the refusal clause allow? A religious employer may require issuers of its health-insurance plans to exclude coverage for contraception.
Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? No. The law carefully defines the term "religious employer" as a tax-exempt entity that is organized and operated for religious purposes, has a primary purpose of inculcating religious values, and primarily employs persons who share the religious tenets of the entity. This definition appropriately covers religious entities but not broad-based entities that operate in the public sphere.
Does the law require that the persons affected by the refusal be notified? Yes. An insurer providing health-benefit plans to a religious employer exercising a religious refusal must provide written notice of the exclusion to each insured. The notice must appear in the plan, application, and sales brochure for the plan.
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 medication ordered for reasons other than contraception or for prescription contraception that is necessary to preserve the life or health of an insured.
Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause? No.
N.C. Gen. Stat. Ann. §§ 58-3-178, 58-50-155 (Enacted 1999).