Insurance Coverage for Contraception
Wisconsin law requires health-insurance plans that cover prescription medication and employers that provide insurance coverage for prescription medication to provide the same coverage for contraception.
What is required? If a health-insurance plan provides coverage for prescription medication, outpatient health-care services, and preventive services, then it must cover FDA-approved prescription contraception. Additionally, if an employer provides its employees insurance coverage for prescription medication, it must provide the same coverage for contraception.
To which insurance plans does the law apply? Every disability insurance policy and self-insured health plan of the state or of a county, city, town, village, or school district. A health-care plan offered by a limited-service health organization, a preferred-provider plan, a health plan that is not a defined network plan, a long-term care insurance policy, or a Medicare replacement or supplement policy are exempt from the contraceptive-equity law.
Does the law provide additional protections for women? Yes. Insurers must cover outpatient consultations, examinations, procedures and medical services that are necessary to prescribe, administer, maintain, or remove a prescription contraceptive, if covered for other prescription medication.
Does the law contain a refusal clause, allowing certain employers and/or insurers to refuse to provide or pay for contraceptive coverage? No
Has a court considered the constitutionality of this law? No.
What is the legal basis for the health-insurance plan requirement? In 2009, the Wisconsin Assembly approved a provision in the state budget which explicitly requires all insurance plans that cover prescription medication to include equitable coverage for contraception.
What is the legal basis for the employer requirement? In 2004, a state agency, the Equal Rights Division, ruled that an employer's failure to cover contraceptives constitutes sex discrimination in violation of the Fair Labor Employment Act. In addition, Wisconsin Attorney General Peg Lautenschlager issued a formal, nonbinding opinion that Wisconsin law prohibits employers and state colleges and universities from excluding prescription contraceptives from health-benefit plans if the plans provide coverage for other prescription medication.
Do all employers have to follow the Equal Rights Division's ruling? Yes. All Wisconsin employers must comply with decisions mandating coverage of contraception. The Equal Rights Division enforces the ruling by employee complaints.
Wis. Stat. Ann. §§ 632.895 (17) (Enacted 2009); Wis. Op. Att'y Gen. 1-04 (Aug. 16, 2004); Anderson v. Green Bay, ERD No. CR200300616 (Wis. Dep't Workforce Dev., Equal Rights Div., Aug. 23, 2004).