Many states across the country currently have contraceptive equity laws. These laws generally require health insurance policies that provide coverage for prescription drugs to also provide coverage for prescription drugs or devices that are contraceptives. In order for the drug or device to be considered a contraceptive, the U.S. Food and Drug Administration (FDA) must have approved the use of the drug or device as a contraceptive. The Affordable Care Act (ACA) required all new insurance plans to provide coverage for the full range of FDA-approved contraceptives without cost-sharing for women.

What are Some of the Specific Requirements?

Many laws require any insurance policy that provides coverage for outpatient health care services to also provide coverage for outpatient contraceptive services. Outpatient contraceptive services may include:

  • Consultations;
  • Procedures;
  • Examinations;
  • Other medical services

Most of these laws also require that any deductible, copayment, or coinsurance that is applied to contraceptives must not be greater than the deductible, copayment or coinsurance that is applied to other prescription drugs. Also, the contraceptive coverage must be available to the insured’s covered spouse and other dependents, as well. Nearly all of the contraceptive equity laws are statutes passed by the legislature and signed into state law.

What are Some of the Limitations of These Laws?

The state contraceptive equity laws apply to insurance policies that are regulated under state law. However, this is not the case if the insurance from an employer is through a self-funded or self-insured plan. A self-funded or self-insured plan is any plan where the employer uses its own funds to pay for the health care claims of its employees. Self-funded plans are governed by federal law.
Also, some states have exemptions for religious reasons to their contraceptive equity laws. Religious employers or insurers whose religious tenets prohibit the use of contraceptives are not required to comply with these laws. However, the scope of the religious exemption varies in different states. In fact, the term “religious employer” can be defined differently depending on the state. Moreover, the Affordable Care Act (ACA) narrowed the religious refusal clause. This would lead to less employers being exempted. State laws with broader religious refusal clauses were expected to align with the federal definition. In some states, the religious employer is required to provide clear notice of its refusal to cover contraception. Also, some states do not allow for religious exemptions if the prescription is ordered for reasons other than birth control.

For example, in California, churches and associations of churches are religious employers. Consequently, they are exempt from the state contraceptive equity law. They are not required to provide contraceptive coverage. However, the religious employer must provide written notice which lists the contraceptive health services that the employer refuses to cover. This is especially the case if an offer of employment has been made. The notice must be given before the employee starts employment. Also, the religious employer is required to provide coverage for contraceptives that are requested for reasons other than to prevent unintended pregnancy. The religious employer must also provider contraception when it is necessary to preserve the life or health of the enrollee.

How to Protect Your Rights Under State Contraceptive Equity Laws?

Insurance complaint procedures differ from state to state. Typically, you can file a complaint with the state insurance department for a complaint regarding the exclusion of contraceptive coverage. This is if the state in which you are in has a contraceptive equity law. The department will then investigate the matter and attempt to resolve it with the insurance company. In fact, you may first need to attempt to resolve the issue with the insurance company before filing a complaint with the state insurance department.

As a side note, employers are required to comply with all of the applicable laws against sex discrimination. This may provide you with a separate basis to assert your right to contraceptive coverage.

Should I Contact a Lawyer?

You may not be receiving contraceptive coverage which you are legally entitled to. To ensure that your rights are protected, consult an experienced employment law attorney today.