Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
SYNOPSIS
Clarifies coverage requirements for health insurers of over-the-counter contraceptive drugs.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health insurance coverage for contraceptives and amending P.L.2005, c.251 and P.L.2021, c.376.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.2005, c.251 (C.17:48-6ee) is amended to read as follows:
1. a. A hospital service corporation that provides hospital or medical expense benefits shall provide coverage under every contract delivered, issued, executed or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, for expenses incurred in the purchase of prescription and over-the-counter female contraceptives, and the following services, drugs, devices, products, and procedures on an in-network basis:
(1) Any contraceptive drug, device or product approved by the United States Food and Drug Administration, which coverage shall be subject to all of the following conditions:
(a) If there is a therapeutic equivalent of a prescription contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested prescription contraceptive drug, device or product or for one or more therapeutic equivalents of the requested prescription drug, device or product.
(b) Coverage shall be provided without a prescription or provider order for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(c) Coverage shall be provided without any infringement upon a subscriber's choice of contraception [and medical]. Medical necessity shall be determined by the provider for covered prescription contraceptive drugs, devices or other products approved by the United States Food and Drug Administration. Medical necessity for over-the-counter contraceptive drugs shall be deemed to be present.
(2) Voluntary male and female sterilization.
(3) Patient education and counseling on contraception.
(4) Services related to the administration and monitoring of drugs, devices, products and services required under this section, including but not limited to:
(a) Management of side effects;
(b) Counseling for continued adherence to a prescribed regimen;
(c) Device insertion and removal;
(d) Provision of alternative contraceptive drugs, devices or products deemed medically appropriate in the judgment of the subscriber's health care provider; and
(e) Diagnosis and treatment services provided pursuant to, or as a follow-up to, a service required under this section.
b. The coverage provided shall include prescriptions for dispensing contraceptives for:
(1) (Deleted by amendment, P.L.2021, c.376)
(2) up to a 12-month period at one time.
c. (1) Except as provided in paragraph (2) of this subsection, the benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imposed. Point-of-sale coverage for over-the-counter female contraceptives shall be provided without cost-sharing or medical management restrictions.
(2) In the case of a high-deductible health plan, benefits for male sterilization or male contraceptives shall be provided at the lowest deductible and other cost-sharing permitted for a high-deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223).
d. This section shall apply to those contracts in which the hospital service corporation has reserved the right to change the premium.
e. Nothing in this section shall limit coverage of any additional preventive service for women, as identified or recommended by the United States Preventive Services Task Force or the Health Resources and Services Administration of the United States Department of Health and Human Services pursuant to the provisions of 42 U.S.C. 300gg-13.
(cf: P.L.2021, c.376, s.1)
2. Section 2 of P.L.2005, c.251 (C.17:48A-7bb) is amended to read as follows:
2. a. A medical service corporation that provides hospital or medical expense benefits shall provide coverage under every contract delivered, issued, executed or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, for expenses incurred in the purchase of prescription and over-the-counter female contraceptives, and the following services, drugs, devices, products, and procedures on an in-network basis:
(1) Any contraceptive drug, device or product approved by the United States Food and Drug Administration, which coverage shall be subject to all of the following conditions:
(a) If there is a therapeutic equivalent of a prescription contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested prescription contraceptive drug, device or product or for one or more therapeutic equivalents of the requested prescription drug, device or product.
(b) Coverage shall be provided without a prescription or provider order for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(c) Coverage shall be provided without any infringement upon a subscriber's choice of contraception [and medical]. Medical necessity shall be determined by the provider for covered prescription contraceptive drugs, devices or other products approved by the United States Food and Drug Administration. Medical necessity for over-the-counter contraceptive drugs shall be deemed to be present.
(2) Voluntary male and female sterilization.
(3) Patient education and counseling on contraception.
(4) Services related to the administration and monitoring of drugs, devices, products and services required under this section, including but not limited to:
(a) Management of side effects;
(b) Counseling for continued adherence to a prescribed regimen;
(c) Device insertion and removal;
(d) Provision of alternative contraceptive drugs, devices or products deemed medically appropriate in the judgment of the subscriber's health care provider; and
(e) Diagnosis and treatment services provided pursuant to, or as a follow-up to, a service required under this section.
b. The coverage provided shall include prescriptions for dispensing contraceptives for:
(1) (Deleted by amendment, P.L.2021, c.376)
(2) up to a 12-month period at one time.
c. (1) Except as provided in paragraph (2) of this subsection, the benefits shall be provided to the same extent as for any other service, drug, device, product, or procedure under the contract, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imp