Insurance Coverage for ContraceptionWest Virginia 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 and outpatient contraceptive services.
To which insurance plans does the law apply? Certain individual and group health-insurance plans issued by accident and sickness insurers, health maintenance organizations, fraternal benefit societies, hospital service corporations, the West Virginia Public Employees Insurance Agency, health-care service corporations, health-service corporations, multiple employee trusts, and multiple employer welfare arrangements.
Does the law provide additional protections for women? Yes. A health insurer is prohibited from: (1) denying an individual coverage because of their use or potential use of contraceptives; (2) providing monetary payments to individuals to encourage them to accept less than the minimum protections under the law; (3) penalizing or reducing or limiting the a health-care professional's reimbursement because he/she prescribed or provided contraception; or (4) providing incentives to a health-care professional to induce him/her to withhold contraception from covered individuals.
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 contraception is contrary to their religious tenets.
What does the refusal clause allow? An employer may exclude or restrict from any health-insurance plan benefits for any prescription contraceptive that are contrary to the religious employer's religious tenets.
Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? Yes. The law broadly defines the term "religious employer" as a non-profit organization or an organization listed in the Official Catholic Directory that holds sincere religious or moral convictions that are central to the employer's operating principles. This exemption allows a broad range of organizations engaged in secular activities to deny women insurance coverage for contraception.
Does the law require the refusing entity to notify the persons affected? No. However, the health insurer must provide written notice to prospective enrollees, listing the contraceptive healthcare services that the employer refuses to cover for religious reasons.
Are there circumstances under which a refusal clause may not be exercised? Yes. The refusal clause may not be exercised to exclude coverage for prescription contraception supplies ordered by a health-care provider for reasons other than contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or to preserve the life or health of an enrollee.
Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause? Yes. A health insurer must make available for purchase at the prevailing group rate a rider that provides prescription contraception.
W. Va. Code Ann. §§ 33-16E-1 to -7 (Enacted 2005).