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Contraceptive Equity Laws in Your State: Know Your Rights - Use Your Rights, A Consumer Guide

Access to safe and reliable contraception is an essential component of health care for women. The health care law, the Affordable Care Act (ACA), appropriately recognizes contraception as a key preventive health service for women, and requires all new insurance plans to provide coverage of the full range of FDA-approved contraceptives without cost-sharing for women. Before this important national victory for women’s health, some health insurance plans excluded coverage for prescription contraceptives even while covering other prescription drugs and devices and preventive care. That gender gap in health care coverage was challenged by states all across the country, which specifically passed laws to require contraceptive equity in health insurance coverage. There are 26 states with contraceptive equity laws. These state laws are the focus of this Consumer Guide.

Effect of the Health Care Law on State Contraceptive Equity Laws

Since the health care law requires contraceptive coverage without cost-sharing nationwide, questions have arisen about the continued relevance of the state contraceptive equity laws and the ways in which they interact with the health care law.  There are two important areas of interaction to consider.  First, the ACA leaves a temporary gap in coverage that the state contraceptive equity laws help close. Second, broad religious refusal clauses in the state contraceptive equity laws are overridden by the federal requirement.

Filling in a temporary gap.  The state contraceptive equity laws reach plans that are otherwise exempt from the ACA’s contraceptive coverage no-cost sharing requirement.  The ACA exempts grandfathered plans – those that existed before the health care law – from providing contraceptive coverage without cost-sharing.  However, grandfathered plans are, for the most part, subject to state contraceptive equity laws and must continue to comply with those laws.  This means that although a plan might be able to avoid the ACA requirement to provide contraceptive coverage without cost-sharing, it is still bound by its state contraceptive equity law and must provide contraceptive coverage.  Women in those plans will not receive the benefit of no cost-sharing, but will at least continue to have insurance coverage for contraception.  Eventually, all plans are expected to lose grandfathered status and all women with private insurance will receive no-cost contraceptive coverage, but the state contraceptive equity laws are an important backstop until that happens.

Narrowing religious refusal clauses. A second area of interaction between the ACA and the state contraceptive equity laws is religious refusal clauses. As described below, some of the state contraceptive equity laws have religious refusal clauses that exempt certain religious employers from compliance with the law. There is also a religious refusal clause for the ACA’s contraceptive coverage requirement.1 The Obama Administration has proposed that state laws with broader religious refusal clauses – those that exempt more employers – are overridden by the federal definition and must be narrowed to align with the federal definition.  This means that  some religious employers that were exempt from the state law must now comply with the ACA’s contraceptive coverage without cost-sharing requirement. Women working for those employers will now benefit from contraceptive coverage without cost sharing.

 

States with Contraceptive Equity Laws: 

Arizona               Iowa                New York  

Arkansas           Maine                   North Carolina

California          Maryland               Oregon

Colorado           Massachusetts       Rhode Island

Connecticut      Missouri                 Vermont

Delaware          Nevada                 Washington

Georgia            New Hampshire West Virginia

Hawaii              New Jersey             Wisconsin

Illinois              New Mexico

 

What This Guide Does

This Consumer Guide is intended to assist individuals across the country in asserting their rights under the state contraceptive equity laws that guarantee health insurance coverage of prescription contraceptives in insurance policies that cover other prescription drugs and devices. The 26 states that currently have contraceptive equity laws are: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, Washington, West Virginia, and Wisconsin. This Guide provides an introduction to these laws and describes how to implement your rights if you live in a state that has a contraceptive equity law and you are enrolled in a plan that is exempt from the health care law's contraceptive coverage no cost-sharing requirement.  In addition, this Guide describes other rights you might have to contraceptive coverage if you live in a state without a contraceptive equity law or if your state’s law does not apply to you.  This Guide includes a state-by-state chart, which tells you whether the state has a contraceptive equity law and who is covered by the law; provides information and links about filing a complaint in your state if you believe you are being denied contraceptive coverage in violation of the state law; and in a separate chart, explains whether the state has a religious refusal clause and to whom it applies.

What the Contraceptive Equity Laws Do

In general, each of the state contraceptive equity laws provides that a health insurance policy that is issued in that state, and that provides coverage for prescription drugs generally, must provide coverage for any prescription drug or device that has been approved by the United States Food and Drug Administration (FDA) for use as a contraceptive. Most also require that if an insurance policy provides coverage for outpatient health care services, it must provide coverage for outpatient contraceptive services, such as consultations, examinations, procedures, and other medical services. Most of the laws further provide that any deductible, copayment, or coinsurance that is applied to contraceptives may not be greater than the deductible, copayment, or coinsurance applied to other prescription drugs. Several of the laws mandate that the contraceptive coverage requirement applies to both the insured and the insured’s covered spouse and other dependents. These laws are statutes passed by the legislature and signed into state law, except in Washington State, where the Insurance Commissioner issued an administrative rule mandating contraceptive equity.

It is important to be aware of limitations on the scope of these laws. The state contraceptive equity laws covered in this Guide apply to insurance policies regulated under state law. If you receive your insurance through an employer that insures its employees through a “self-funded” or “self-insured” plan—that is, where an employer uses its own funds to pay the health care claims of its employees rather than buying an insurance plan from an outside insurer—the state contraceptive equity law will not apply (even if an outside firm is hired by the employer to administer the plan). This is because the “self-funded” plans are considered to be employer benefit plans that are governed by federal law2 rather than state insurance laws. However, in such a case, your plan might be covered by the health care law. Additionally, your employer is obligated to comply with applicable laws against sex discrimination in employment which, as explained below, can provide a separate basis for asserting your right to contraceptive coverage (see “What Other Rights You Have,” below).

Some states have enacted religious refusal clauses—that is, exceptions to the contraceptive equity mandate for religious employers or insurers (or individuals enrolled in the plan) whose religious tenets prohibit the use of contraceptives. These laws define the scope of the religious exception in various ways. The second state-by-state chart below provides information on how each state law with a religious refusal clause defines “religious employer.” The chart then applies that definition, explaining which employers would be exempt under the law and which would have to provide contraceptive coverage. It also explains how the state refusal clause compares to the federal one. It is important to note, however, that in some states with such a religious exception, the religious entity is required to provide clear notice of its refusal to cover contraception; and in a few states, like New York and Hawaii, the law goes further and says that if your employer is covered by the religious exception, you have the right to purchase contraceptive coverage directly from the insurance company3. Some of the religious exceptions also specify that they do not apply if the prescription is ordered for reasons other than birth control, such as to address menopause symptoms, or if it is necessary to preserve the life or health of the person insured.

Finally, there are several states that mandate coverage of “family planning services” by HMOs, but do not appear to have interpreted these laws to require coverage of contraceptive drugs and devices. These states are: Minnesota, North Dakota, Ohio, Oklahoma, and Wyoming. In addition, Virginia and Texas4 require insurers to offer contraceptive coverage as an employer option, but do not require employers to purchase this coverage. Similarly, Idaho and Kentucky require small-group and individual market carriers to offer standardized plans to employers that include coverage of contraceptives, but do not require employers to select these plans.

How to Implement Your Rights Under the Contraceptive Equity Laws

The state contraceptive equity laws are incorporated into state insurance laws, and they are administered and enforced in the same manner as other state insurance requirements, governing matters such as marketing practices, premiums that may be charged, and other consumer protections. The state regulations include provisions governing how complaints are handled when people do not receive the benefits they believe they are entitled to under their insurance plans. Typically, if you have a complaint about the exclusion of contraceptive coverage from your health insurance in a state with a contraceptive equity law, you may file a complaint with the state insurance department, which will then investigate the matter and attempt to resolve it with the insurance company. You may be required or urged to try to resolve the issue with your insurance company yourself before filing a complaint with the state insurance department.

The way to file such a complaint in each state is described in the chart below; often, it can be done by filing a form electronically. Once it receives a complaint, the insurance department will initially attempt to resolve the matter by informing the insurance company about the complaint and the relevant legal requirements. Because the contraceptive equity requirements are clear statutory mandates, disputes in this area are likely to be resolved quickly and without resort to formal enforcement action. But if the insurance department is unable to resolve the matter simply by contacting the insurance company and demanding compliance, it generally has the authority to take formal action to enforce the law, and may also be empowered to impose fines, penalties, or even suspension or revocation of the company’s license to do business in the state. An individual may also have the right to file a lawsuit for breach of her insurance contract or on other legal grounds.5

What Other Rights You Have

Apart from the state contraceptive equity laws described in this Guide, there are other laws, including federal and state anti-discrimination laws, that may be invoked to obtain contraceptive coverage.

The Health Care Law (Affordable Care Act)

The health care law requires all new insurance plans to provide coverage of all FDA-approved methods of contraception, and related education and counseling, without cost-sharing. This new benefit began taking effect on August 1, 2012 – plans must include this coverage at the start of the next plan year on or after that date.  Your access to this coverage will depend on when your plan’s new year begins. Health plans that existed before the health care law are considered “grandfathered” into the new system and do not have to follow the new preventive services cost sharing rules. For more information on this benefit and how to make sure you are getting the coverage to which you are entitled, visit http://www.nwlc.org/preventive-services-including-contraceptive-coverage....    

Federal Anti-Discrimination Law

The federal law against sex discrimination in employment, Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e-2(a)(1), has been interpreted to prohibit employers who offer otherwise comprehensive health benefits to their employees, including coverage of prescription drugs and devices generally, from excluding coverage of prescription contraceptives. This law covers all private employers with 15 or more employees, as well as state and local governments as employers. See U.S. Equal Employment Opportunity Commission, Commission Decision on Coverage of Contraception (Dec. 14, 2000), http://www.eeoc.gov/policy/docs/decision-contraception.html; Erickson v. Bartell Drug Co., 141 F. Supp. 2d 1266 (W.D. Wash. 2001). Thus, if you obtain your health insurance through your employee benefits plan, and you work for a government or for a private employer with at least 15 employees, you have a right to contraceptive coverage under federal law if your plan covers other prescription drugs and devices. If you live in Arkansas, Iowa, Minnesota, Missouri, Nebraska, North Dakota, or South Dakota, a federal court decision may implicate your Title VII protection. In re Union Pacific Railroad Employment Practices Litigation, 479 F.3d 936 (8th Cir. 2007). For more information on how to assert this right, see the National Women’s Law Center’s guide for employees, Take Action: Get Your Prescription Contraceptives Covered.

State Anti-Discrimination Laws

Almost every state has a law against sex discrimination in employment along the same lines as federal law (Title VII). In light of the fact that Title VII has been interpreted as placing a contraceptive coverage requirement on employers who are covered by federal law, similar state laws should be interpreted in the same way, and already have been in three states: Wisconsin, Montana, and Michigan.

In Wisconsin, the state Attorney General has issued two opinions finding that contraceptive coverage is required by state law.6 The Attorney General’s opinions cite Erickson and the EEOC decision and holds that Wisconsin’s Fair Employment Act should be interpreted, like Title VII, to require employers to include contraceptive coverage, and further that Wisconsin’s law prohibiting sex discrimination in education applies the same principle to contraceptive coverage for students of Wisconsin colleges and universities.

The Montana Attorney General in 2006 ruled that Montana state law requires contraceptive coverage as well.7 The Attorney General opinion cites Erickson, the Union Pacific district court decision, and the EEOC decision and holds that the Montana Human Rights Act, like Title VII, requires that employer benefit plans providing coverage for prescription drugs and other medical services must cover prescription contraception and related medical services. The Attorney General also found that Montana’s “unisex” insurance law requires this coverage. 

In August 2006, the Michigan Civil Rights Commission determined that contraceptive coverage is required by the state’s Elliott-Larsen Civil Rights Act (ELCRA).8 The Commission discussed Erickson, the Union Pacific district court decision and the EEOC decision before ruling that the language of ELCRA clearly prohibits employers from excluding prescription contraceptive coverage from otherwise comprehensive health plans. 

If you are not in one of the states with contraceptive equity laws or your plan is self-insured, and your employer is too small to be covered by Title VII, you may be able to invoke the state’s sex discrimination law to obtain contraceptive coverage.

If You Need Help

If you would like assistance in exercising your rights under any of the applicable state or federal laws, please contact the National Women’s Law Center. You may call our toll-free information line at 1-866-PILL4US or email us at info@nwlc.org.

 


 

1 The federal contraceptive coverage without cost sharing requirement exempts an organization that (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization that meets certain provisions of the federal tax code, which refer to churches, their integrated auxiliaries, and conventions or associations of churches, as well as the exclusively religious activities of any religious order. 

2 The federal law, which you may hear discussed, is “ERISA,” the Employee Retirement Income Security Act, 29 U.S.C. §§ 1001- 1461 (1974).

3 For more information on notice requirements, see the National Women’s Law Center’s report, Truth or Consequences: Using Consumer Protection Laws to Expose Institutional Restrictions on Reproductive and Other Health Care, http://www.nwlc.org/pdf/TruthOrConsequences2003.pdf.

4 A Texas law applies to plans delivered, issued, or renewed after January 1, 2004. Tex. Ins. Code Ann. art. 3.80 (West 2006). For plans issued prior to that date, Texas has a comprehensive contraceptive equity law requiring that all health insurance plans issued in the state that offer prescription coverage include contraceptive coverage. TEX. INS. CODE ANN. art. 21.52L, §3 (West 2006).

5 The information contained in this Guide was collected through online research, statutory review, and telephone interviews and correspondence with relevant state officials. Since few complaints under contraceptive equity laws have been filed to date, this Guide lays out how such complaints would ordinarily be handled based on the practices of each of the states in addressing other state insurance mandates.

6 Letter from Wisconsin Attorney General Peggy A. Lautenschlager to state Senator Gwendolynne Moore, October 17, 2003; Letter from Wisconsin Attorney General Peggy A. Lautenschlager to Secretary, Helene Nelson, Wisconsin Department of Health and Family Services, August 16, 2004.

7 Opinion issued by Montana Attorney General Mike McGrath, Vol. 51, No. 16, March 28, 2006, available at http://www.doj.mt.gov/resources/ opinions2006/51-016.pdf.

8 Michigan Civil Rights Commission, Declaratory Ruling on Contraceptive Equity, August 21, 2006, available at http://www.michigan.gov/documents/Declaratory_Ruling_7-26-06_169371_7.pdf.

 

State Contraceptive Equity Laws

State
Does the state have a contraceptive equity law? To which types of plans does it apply
Where can I find the law?
How to file a complaint

Note: Before filing a complaint, you should contact your insurance company, agent, or broker in an effort to resolve the issue.

Alabama  No    
Alaska  No    
Arizona Yes- group health insurance policies  ARIZ. REV. STAT. ANN. § 20-826Y(1)–(3) (corporation)

ARIZ. REV. STAT. ANN. § 20-1057.08A(1)–(2) (health care services organization)

ARIZ. REV. STAT. ANN. § 20-1402L(1)–(2)(group disability policy) 

ARIZ. REV. STAT. ANN. §20-1404U(1)–(2)(blanket disability policy)

ARIZ. REV. STAT. ANN.§ 20-2329A(1)–(2)(accountable health plan)

You may file a complaint by mailing or faxing a Request for Assistance form to the Arizona Insurance Department, and include copies of all relevant documents with your complaint.

Arkansas Yes – every individual or group plan, policy or contract for health care services 

ARK. CODE ANN. § 23-79-1101-1104

(Note: A link to the specific law is unavailable; you will have to search the Arkansas code available at this link)

 

You can file a written complaint through the Consumer Services Division of the Arkansas Insurance Departmenteither by writing a letter, requesting a Complaint Form, or submitting the on-line form. 
California Yes – every individual or group health insurance policy  CAL. INS. CODE § 10123.196   You may fill out a Request for Assistance Form and submit it online or mail it to the California Department of Insurance 

Colorado

Yes- group and individual policies

CO. REV. STAT. § 10-16-104(3) (search code)

You may submit a complaint on-line to the Colorado Division of Insurance. 
Connecticut Yes – each individual and group health insurance policy 

CONN. GEN. STAT. ANN. § 38A-503e (individual policies)

CONN. GEN. STAT. ANN. § 38A-530e (group policies)

You may file a Consumer Complaint with the Connecticut Insurance Department, either by filling out a form online or writing a letter to the Department that contains a full description of the problem.
Delaware Yes - all group and blanket health insurance policies  DEL. CODE ANN tit 18 § 3559   You may file a complaint online or mail it in, or call, email or visit the Delaware Department of Insurance. 
District of Columbia  No    
Florida  No    
Georgia Yes - every individual or group health plan, policy or contract  GA. CODE ANN. § 33-24-59.6  The Georgia Insurance and Fire Safety Commissioner handles complaints. 
Hawaii Yes - each employer group health policy, contract, plan or agreement  

HAW. REV. STAT. ANN. § 431:10A-116.6

HAW. REV. STAT. ANN. § 432:1-604.5 

You may  file a complaint with the Hawaii Insurance Division.
Idaho  No    
Illinois  Yes 215 ILL. COMP. STAT. ANN. 5/356Z.4  You may file a complaint with the Illinois Department of Insurance. 
Indiana  No    
Iowa Yes - an individual or group health insurance policy or contract 

IOWA CODE ANN. § 514C.19

(Note: A link to the specific law is unavailable; you will have to search the Iowa code available at this link)

 

You may file a complaint with the Iowa Insurance Division.
Kansas   No    
Kentucky  No    
Louisiana  No    
Maine Yes - all individual or group health insurance plans 

ME. REV. STAT. ANN. tit. 24, § 2332-J (individual and group nonprofit hospital and medical services and health care plans)

ME. REV. STAT. ANN. tit. 24-A, § 2756(individual health policies and contracts)

ME. REV. STAT. ANN. tit. 24-A, § 2847-G (group insurance policies and contracts)

ME. REV. STAT. ANN. tit. 24-A, § 4247  (health maintenance organization individual and group

You may file a complaint with the Maine Bureau of Insurance.
Maryland Yes - insurers, nonprofit health service plans, and health maintenance organizations  MD. CODE ANN., INS. § 15-826  You may file a complaint with the Maryland Insurance Administration. 
Massachusetts Yes - an individual or group plan  

MASS. GEN. LAWS ANN. ch. 175 § 47W (accident and sickness insurance)

(Note: A link to the specific law is unavailable; you will have to search the Massachusetts code available at this link.)

MASS. GEN. LAWS ANN. ch. 176A § 8W  (hospital service plan)

MASS. GEN. LAWS ANN. ch. 176B § 4W  (medical service agreement)

MASS. GEN. LAWS ANN. ch. 176G § 4O  (health maintenance contract)

You may file a complaint with the Massachusetts Division of Insurance.
Michigan No contraceptive equity law, but the state’s anti-discrimination law has been interpreted to require contraceptive coverage. Please see description under State Anti-Discrimination Laws above for more details.    
Minnesota  No    
Mississippi  No    
Missouri Yes - each health carrier or health benefit plan  MO. REV. STAT. § 376.1199-1(4)  You may file a complaint with the Department of Insurance, Financial Institutions & Professional Registration. 
Montana No contraceptive equity law, but the state’s anti-discrimination law has been interpreted to require contraceptive coverage. Please see description under State Anti-Discrimination Laws above for more details.    
Nebraska  No    
Nevada Yes - an individual or group health insurer 

NEV. REV. STAT. ANN. §§ 689A.0415, .0417(individual) 

NEV. REV. STAT. ANN. §§ 689B.0376, .0377 (group)

You may file a complaint with the Division of Insurance of the Nevada Department of Business and Industry.
New Hampshire Yes - group or blanket health policy 

N.H. REV. STAT. ANN. § 415:18-i (insurer)

N.H. REV. STAT. ANN. § 420-A:17-c (health service corporation)

N.H. REV. STAT. ANN. § 420-B:8-gg (health maintenance organization)

You may  file a complaint with the New Hampshire Insurance Department.
New Jersey Yes - each hospital service corporation, medical service corporation, health service corporation, group health insurer, individual insurer, health maintenance organization, individual health benefits plan, small employer health benefits plan, prepaid prescription service organization 

NJ STAT. ANN. § 17:48-6ee (hospital service corporation)

N.J. STAT. ANN. § 17:48a-7bb (medical service corporation)

N.J. STAT. ANN. § 17:48E-35.29 (health service corporation)

N.J. STAT. ANN. § 17:48F-13.2 (prepaid prescription service organization)

N.J. STAT. ANN. § 17B:26-2.1y (individual health insurer)

N.J. STAT. ANN. § 17B:27-46.1ee (group health insurer)

N.J. STAT. ANN. § 17B:27A-7.12 (individual health benefits plan)

N.J. STAT. ANN. § 17B:27A-19.15 (small employer health benefits plan)

N.J. STAT. ANN. § 26:2J-4.30 (health maintenance organization)

N.J. STAT. ANN. § 52:14-17.29j (contract under State Health Benefits Commission)

(Note: A link to the specific law is unavailable; you will have to search New Jersey statutes available at this link)
http://lis.njleg.state.nj.us/cgi-bin/om_isapi.dll?clientID=224050&depth=2&expandheadings=off&headingswithhits=on&infobase=statutes.nfo&softpage=TOC_Frame_Pg42

 

You may file a complaint with the New Jersey Department of Banking and Insurance.
New Mexico Yes - each individual and group health insurance policy, health care plan, certificate of health insurance, and health maintenance contract 

N.M. STAT. ANN. 59A-22-42 (health insurance policy, plan, or certificate)

N.M. STAT. ANN. § 59A -46-44 (health maintenance organization contract)

(Note: A link to the specific laws is unavailable; you will have to search the New Mexico code available at this link)

You may file a complaint with the New Mexico Insurance Bureau.
New York Yes - every group or blanket policy  N.Y. INS. § 3221(1)(16)  You may file a complaint with the New York Insurance Department.
North Carolina Yes - every insurer providing an individual or group health benefit plan  N.C. GEN STAT. ANN. § 58-3-178  You may file a complaint with the North Carolina Department of Insurance.
North Dakota  No    
Ohio  No    
Oklahoma  No    
Oregon Yes - each prescription drug benefit program or prescription drug benefit offered under a health benefit plan or under a student health insurance policy  OR. REV. STAT. § 743A.066  You may file a complaint with the Insurance Division of the Oregon Department of Consumer and Business Services.
Pennsylvania  No    
Rhode Island Yes - every individual or group health insurance contract, plan or policy 

R.I. GEN. LAWS § 27-19-48 (hospital service corporation)

R.I. GEN. LAWS § 27-18-57 (accident and sickness insurance policy)

R.I. GEN. LAWS § 27-20-43 (medical service corporation)

You may file a complaint with the Insurance Division of the Rhode Island Department of Business Regulation.
South Carolina  No    
South Dakota  No    
Tennessee  No    
Texas  No    
Utah  No    
Vermont Yes - any individual or group health insurance plan   VT. STAT. ANN. tit. 8, § 4099c  You may file a complaint  with the Insurance Division of the Vermont Department of Banking, Insurance, Securities and Health Care Administration.
Virginia  No    
Washington An administrative rule issued by the state Insurance Commissioner on September 5, 2001 mandates contraceptive coverage in Washington state and has the force of law.  It applies to any health carrier.  WASH. ADMIN CODE 284-43-822  You may file a complaint  with the Washington State Office of the Insurance Commissioner.
West Virginia Yes – individual and group health plans  W. VA. CODE ANN. § 33- 16E   You may file a complaint with the West Virginia Insurance Commission.
Wisconsin

Yes - every disability insurance policy and every self-insured health plan

Additionally, state anti-discrimination laws have been interpreted to require contraceptive coverage. Please see description under State Anti-Discrimination Laws above for more details.

 

WISC. STAT. ANN. § 632.895 (17)  You may file a complaint with the Wisconsin Office of the Commissioner of Insurance
Wyoming  No    

 

 

States with Religious Employer Exemptions

 


State


Does the state law have a religious refusal clause? If so, where can I find it?


Which religious employers would not have to provide contraceptive coverage? How does it compare to the religious refusal clause in the health care law?


Are there protections for consumers who work for those religious employers?

Alabama

Does not have a contraceptive equity law.

N/A

N/A

Alaska

Does not have a contraceptive equity law.

N/A

N/A

Arizona

 

 

 

Yes

 

Ariz. Rev. Stat. Ann.§ 20-826Z, AA(3) (corporation)

http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/ars/20/00826.htm&Title=20&DocType=ARS

 

Ariz. Rev. Stat. Ann. § 20-1057.08B–G (health care services organization)

http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/ars/20/01057-08.htm&Title=20&DocType=ARS

 

Ariz. Rev. Stat. Ann. § 20-1402M,  N(3) (group disability policy)

http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/ars/20/01402.htm&Title=20&DocType=ARS

 

Ariz. Rev. Stat. Ann. § 20-1404V, W(3) (blanket disability policy) http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/ars/20/01404.htm&Title=20&DocType=ARS

 

Ariz. Rev. Stat. Ann.§ 20-2329B–F  (accountable health plan)

http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/ars/20/02329.htm&Title=20&DocType=ARS

 

Churches and associations of churches would not have to provide contraceptive coverage.

 

In 2012, the state legislature added an exemption for “an entity whose articles of incorporation clearly state that it is a religiously-motivated organization and whose religious beliefs are central to the organization’s operating principles.” It is unclear to which employers this applies.

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

Religious employers must file with the issuer a written affidavit stating the refusal.

 

Must provide coverage for prescription contraceptive methods ordered for reasons other than for “contraceptive, abortifacient, abortion or sterilization purposes.” 

 

Religious employers may not obtain an employee’s protected health information or violate HIPAA.

 

Protections against employment discrimination in federal and state law cannot be restricted or limited by this law. 

 

Arkansas

 

 

Yes

 

Ark. Code Ann. §§ 23-79-1104(b)(3),  23-79-1102(3)(A)–(C)

http://www.lexis-nexis.com/hottopics/arcode/

Religious employers that would not have to provide contraceptive coverage:

  • Churches
  • Church-affiliated schools that  primarily employ persons who share their religious tenets, and have the inculcation of religious values as one of their primary purposes
  • Nonprofit religious charities that primarily employ persons who share their religious tenets, and have the inculcation of religious values as one of their primary purposes

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

No protections for consumers working for exempt religious employers.

 

 

 

California

 

 

Yes

 

Cal. Ins. Code § 10123.196(d)

http://www.leginfo.ca.gov/cgi-bin/displaycode?section=ins&group=10001-11000&file=10110-10127.18

 

Note: This narrow religious exception was upheld in Catholic Charities of Sacramento, Inc. v. Superior Court, 85 P.3d 67 (Cal. 2004), cert. denied, 543 U.s. 16 (2004).

Religious employers that would not have to provide contraceptive coverage:

  • Churches and associations of churches

 

This religious refusal clause is the same as the religious refusal clause in the health care law.

Once an offer of employment has been made and before a prospective employee commences employment, the religious employer must provide written notice listing the contraceptive health services the employer refuses to cover.

 

Must provide coverage for prescription contraceptive methods ordered for reasons other than to prevent unintended pregnancy or for prescription contraception that is necessary to preserve the life or health of the enrollee. 

Colorado

 

 

The contraceptive equity law does not have a religious refusal clause.

N/A

N/A

Connecticut

 

 

Yes

 

Conn. Gen. Stat. Ann. § 38a-503e(b)–(f) (individual policies)

http://www.cga.ct.gov/2009/pub/chap700c.htm#Sec38a-503e.htm

 

Conn. Gen. Stat. Ann. § 38a-530e(b)–(f) (group policies)

http://www.cga.ct.gov/2009/pub/chap700c.htm#Sec38a-530e.htm

 

Religious employers that would not have to provide contraceptive coverage:

  • Churches and associations of churches
  • Elementary and secondary schools that are controlled, operated, or principally supported by churches and associations of churches
  • Other nonprofit church-affiliated colleges, religious charities, or hospitals that meet certain criteria.

 

The law also exempts “a church-affiliated organization.” It is unclear to which employers this applies.

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

Any health insurance policy issued pursuant to a religious exemption must provide written notice of the refusal to each insured or prospective insured.

 

Must provide coverage for prescription contraceptive methods ordered for reasons other than to prevent unintended pregnancy. 

 

If an insurer is owned, operated, or substantially controlled by a religious organization, and has religious or moral tenets that conflict with the contraceptive coverage requirement, it may provide coverage as required by state law through another entity.  The costs, terms, and availability of such coverage may not differ from the cost, terms, and availability of other prescription coverage offered to the insured.

Delaware

 

 

Yes

 

Del. Code Ann tit 18 § 3559(d)

http://delcode.delaware.gov/title18/c035/sc03/index.shtml#3559

 

Note: As with Maryland (whose statute is similarly worded), the discretion to grant or withhold an exclusion from coverage is delegated by the statute to individual insurance companies.  It is unclear how many DE insurance companies have had such exclusions requested, whether DE insurance companies have internal guidelines to determine whether such a request should be granted, and how much variance there is among DE insurance company guidelines.

Unclear

 

Note: Delaware does not provide a definition of the term “religious employer” or “religious organization” elsewhere in the section or in any other statute.

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

A religious employer must provide its employees reasonable and timely notice of the refusal.

District of Columbia

Does not have a contraceptive equity law.

N/A

N/A

Florida

Does not have a contraceptive equity law.

N/A

N/A

Georgia

 

 

The contraceptive equity law does not have a religious refusal clause.

N/A

N/A

Hawaii

 

 

Yes

 

Haw. Rev. Stat. Ann. § 431:10A-116.7

http://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435E/HRS0431/HRS_0431-0010A-0116_0007.htm

 

Religious employers that would not have to provide contraceptive coverage:

  • Churches

 

The law also exempts “any educational, health care or other nonprofit institution or organization owned or controlled by the religious employer.”

 

Note: Mere affiliates of religious employers are not included in HI’s definition – only those institutions that, although they may not meet HI’s definition individually, are either owned or controlled by an employer meeting the definition.  Religious schools, charities, and hospitals are affiliated with religious institutions – but not usually directly owned or controlled by a church – and therefore likely are not part of the exclusion.

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

Religious employers must provide written notice to enrollees upon enrollment with the plan and list the contraceptive health services the employer refuses to cover; provide written information describing how an enrollee may directly access contraceptive services and supplies in an expeditious manner; and ensure that enrollees who are refused contraceptive services and supplies have prompt access to contraceptive information.

 

Must provide coverage for prescription contraceptive methods ordered for reasons other than to prevent unintended pregnancy or for prescription contraception that is necessary to preserve the life or health of an enrollee. 

 

Health insurers must allow enrollees in a health plan exempted for religious reasons to directly purchase coverage of contraceptive supplies and outpatient contraceptive services.  The enrollee’s cost may not exceed the enrollee’s pro rata share of the price the group purchaser would have paid for such coverage had the employer not invoked the religious exemption.

Idaho

Does not have a contraceptive equity law.

N/A

N/A

Illinois

 

 

The contraceptive equity law does not have a religious refusal clause.  However, Illinois has a separate state law [link to http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2082&ChapterID=58] that provides expansive refusal rights for health care services.

N/A

N/A

Indiana

Does not have a contraceptive equity law.

N/A

N/A

Iowa

 

 

The contraceptive equity law does not have a religious refusal clause.

N/A

N/A

Kansas

Does not have a contraceptive equity law.

N/A

N/A

Kentucky

Does not have a contraceptive equity law.

N/A

N/A

Louisiana

Does not have a contraceptive equity law.

N/A

N/A

Maine

 

 

Yes

 

Me. Rev. Stat. Ann. tit. 24, § 2332-J(2) (individual and group nonprofit hospital and medical services and health care plans)

http://www.mainelegislature.org/legis/statutes/24/title24sec2332-J.html

 

Me. Rev. Stat. Ann. tit. 24-A, § 2756(2) (individual health policies and contracts)

http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec2756.html

 

Me. Rev. Stat. Ann. tit. 24-A, § 2847-G(2) (group insurance policies and contracts) 

http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec2847-G.html

 

Me. Rev. Stat. Ann. tit. 24-A, § 4247(2) (health maintenance organization individual and group health contracts)

http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec4247.html

Religious employers that would not have to provide contraceptive coverage:

  • Churches and associations of churches
  • Elementary and secondary schools that are controlled, operated, or principally supported by churches and associations of churches

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

Religious employer must provide prospective insureds and individuals insured under its policy written notice of the refusal.

 

Must provide coverage for prescription contraceptive methods ordered for reasons other than to prevent unintended pregnancy or for prescription contraception that is necessary to preserve the life or health of the enrollee. 

 

Maryland

 

 

Yes

 

Md. Code Ann., Ins. § 15-826(c)  http://law.justia.com/maryland/codes/gin/15-826.html

 

Note: As with Delaware (whose statute is similarly worded), the discretion to grant or withhold an exclusion from coverage is delegated by the statute to individual insurance companies.  It is unclear how many MD insurance companies have had such exclusions requested, whether MD insurance companies have internal guidelines to determine whether such a request should be granted, and how much variance there is among MD insurance company guidelines.

Unclear

 

Note: “Religious organization” is not further defined elsewhere in the section or in any other statute.

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

A religious employer must provide its employees reasonable and timely notice of the refusal.

Massachusetts

 

 

Yes

 

Mass. Gen. Laws Ann. ch. 175 § 47W(c) (accident and sickness insurance)

http://www.mass.gov/legis/laws/mgl/175-47w.htm

 

Mass. Gen. Laws Ann. ch. 176A § 8W(c) (hospital service plan)

http://www.mass.gov/legis/laws/mgl/176a-8w.htm

 

Mass. Gen. Laws Ann. ch. 176B § 4W(c) (medical service agreement)

http://www.mass.gov/legis/laws/mgl/176b-4w.htm

 

Mass. Gen. Laws Ann. ch. 176G § 4O(c) (health maintenance contract)

http://www.mass.gov/legis/laws/mgl/176g-4o.htm

 

Religious employers that would not have to provide contraceptive coverage:

  • Churches and associations of churches
  • Elementary and secondary schools that are controlled, operated, or principally supported by churches and associations of churches
  • Other nonprofit church-affiliated colleges, religious charities, or hospitals that meet certain criteria.

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

No protections for consumers working for exempt religious employers.

 

Michigan

Does not have a contraceptive equity law.  The state anti-discrimination law has been interpreted to require contraceptive coverage, with a religious refusal clause. [link to http://www.michigan.gov/documents/Declaratory_Ruling_7-26-06_169371_7.pdf

Religious employers that would not have to provide contraceptive coverage:

  • Churches and associations of churches

 

According to the ruling that established the religious refusal clause, it could apply beyond churches and associations of churches in limited circumstances, such as “a private religious school or college that only employed members with certain religious values and where religion was a core value that was inextricably linked with all aspects of the school.”

In that sense, this religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

N/A

Minnesota

Does not have a contraceptive equity law.

N/A

N/A

Mississippi

Does not have a contraceptive equity law.

N/A

N/A

Missouri

 

 

Yes

 

Mo. Rev. Stat. § 376.1199-4-7.

http://www.moga.mo.gov/statutes/C300-399/3760001199.HTM

 

Note: According to the law, for the purposes of the religious refusal clause the term “health carrier” has the meaning provided in Mo. Rev. Stat. § 376.1350(22).

http://www.moga.mo.gov/statutes/C300-399/3760001350.HTM

Unclear

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

Unless the health insurance carrier itself is exempt, the carrier must allow an enrollee of a plan that excludes contraceptive coverage to purchase a plan that includes such coverage.

 

A health benefit plan issued pursuant to an exemption must provide clear written notice: whether coverage for contraception is or is not included; that an enrollee of a group plan that includes contraceptive coverage may decline that coverage; and that an enrollee of a group plan that excludes contraceptive coverage may purchase such coverage.

 

A health carrier may not disclose the names of enrollees who purchase or refuse contraceptive coverage.  Health carriers and employers may not discriminate against an enrollee for taking or refusing prescription contraceptives.

Montana

Does not have a contraceptive equity law.  The state anti-discrimination law has been interpreted to require contraceptive coverage, without a specific religious refusal clause.

N/A

N/A

Nebraska

Does not have a contraceptive equity law.

N/A

N/A

Nevada

 

 

Yes

 

Nev. Rev. Stat. Ann. § 689A.0415(5), .0417(5) (individual)

http://www.leg.state.nv.us/NRS/NRS-689A.html#NRS689ASec0415

 

Nev. Rev. Stat. Ann. § 689B.0376(5), .0377(5)–(6) (group)

http://www.leg.state.nv.us/NRS/NRS-689B.html#NRS689BSec0376

 

Note: The section does not define “religious organization.”

This policy only extends to religious insurance companies – not religious employers.  This means that employees of secular organizations whose health insurance is provided through a religious insurer that objects to contraceptive coverage will not have contraceptive coverage, but employees of a religious organization (whether church, religiously-affiliated school, charity or hospital) whose health insurance was administered by a non-religiously affiliated plan would have to be provided contraceptive coverage. 

 

The federal religious refusal does not apply to religious insurance companies.

Before the issuance or renewal of a health insurance policy, an exempted insurer must provide to the prospective insured or the group policyholder written notice of the coverage that the insurer refuses to provide, and must provide such notice to each insured at the time he or she receives notice of coverage under the plan.

New Hampshire

 

 

The contraceptive equity law does not have a religious refusal clause.

N/A

N/A

New Jersey

 

 

Yes

 

NJ Stat. Ann. § 17:48-6ee (hospital service corporation) (search code)  http://lis.njleg.state.nj.us/cgi-bin/om_isapi.dll?clientID=224050&depth=2&expandheadings=off&headingswithhits=on&infobase=statutes.nfo&softpage=TOC_Frame_Pg42

 

N.J. STAT. ANN. § 17:48a-7bb (medical service corporation)

 

N.J. STAT. ANN. § 17:48E-35.29 (health service corporation)

 

N.J. STAT. ANN. § 17:48F-13.2 (prepaid prescription service organization)

 

N.J. STAT. ANN. § 17B:26-2.1y (individual health insurer)

 

N.J. STAT. ANN. § 17B:27-46.1ee (group health insurer)

 

N.J. STAT. ANN. § 17B:27A-7.12 (individual health benefits plan)

 

N.J. STAT. ANN. § 17B:27A-19.15 (small employer health benefits plan)

 

N.J. STAT. ANN. § 26:2J-4.30 (health maintenance organization)

 

(Note: A link to the specific law is unavailable; you will have to search New Jersey statutes available at this link)

http://lis.njleg.state.nj.us/cgi-bin/om_isapi.dll?clientID=224050&depth=2&expandheadings=off&headingswithhits=on&infobase=statutes.nfo&softpage=TOC_Frame_Pg42

 

Religious employers that would not have to provide contraceptive coverage:

  • Churches and associations of churches
  • Elementary and secondary schools that are controlled, operated, or principally supported by churches and associations of churches

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

Religious employers must provide written notice of the refusal to subscribers and potential subscribers.

 

Must provide coverage for prescription contraceptive methods ordered for reasons other than to prevent unintended pregnancy or for prescription contraception that is necessary to preserve the life or health of the enrollee. 

 

New Mexico

 

 

Yes

 

N.M. Stat. Ann. 59A-22-42(D) (health insurance policy, plan, or certificate)

http://www.conwaygreene.com/nmsu/lpext.dll?f=templates&fn=main-h.htm&2.0 

 

N.M. Stat. Ann. § 59A -46-44(C) (health maintenance organization contract)

http://www.conwaygreene.com/nmsu/lpext.dll?f=templates&fn=main-h.htm&2.0

 

(Note: A link to the specific laws is unavailable; you will have to search the New Mexico code available at this link)

 

Unclear

 

Note: “Religious entity” is not defined anywhere in NM statutes.

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

No protections for consumers working for exempt religious employers.

 

New York

 

 

Yes

 

N.Y. Ins. § 3221(1)(16)(A)–(C) http://public.leginfo.state.ny.us/LAWSSEAF.cgi?QUERYTYPE=LAWS+&QUERYDATA=$$ISC3221$$@TXISC03221+&LIST=LAW+&BROWSER=BROWSER+&TOKEN=37994600+&TARGET=VIEW

 

Note: This narrow religious exception was upheld in Catholic Charities of the Diocese of Albany v. Serio, 2006 NY Slip. Op. 07517 (N.Y., Oct. 19, 2006).

 

Religious employers that would not have to provide contraceptive coverage:

  • Churches and associations of churches

 

This religious refusal clause is the same as the religious refusal clause in the health care law.

Enrollees may not be denied coverage of, and timely access to, contraceptive methods.

 

A religious employer must provide a prospective enrollee written notice, prior to enrollment, listing the contraceptive health services the employer refuses to cover. 

 

Must provide coverage for prescription contraceptive methods ordered for reasons other than to prevent unintended pregnancy. 

 

The enrollee has the right to directly purchase a contraceptive coverage rider from the insurer, at the prevailing small group community rate, if his or her employer claims the religious exemption.

North Carolina

 

 

Yes

 

N.C. Gen Stat. Ann. § 58-3-178(e)

 

http://www.ncleg.net/EnactedLegislation/Statutes/HTML/BySection/Chapter_58/GS_58-3-178.html

 

Religious employers that would not have to provide contraceptive coverage:

  • Churches
  • Church-affiliated schools that  primarily employ persons who share their religious tenets, and have the inculcation of religious values as one of their primary purposes
  • Nonprofit religious charities that primarily employ persons who share their religious tenets, and have the inculcation of religious values as one of their primary purposes

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

An insurer must provide written notice to each person covered under the plan that prescription contraceptive drugs or devices are excluded from coverage at the employer’s request.

 

Must provide coverage for prescription contraceptive methods ordered for reasons other than to prevent unintended pregnancy or for prescription contraception that is necessary to preserve the life or health of the enrollee. 

 

North Dakota

Does not have a contraceptive equity law.

N/A

N/A

Ohio

Does not have a contraceptive equity law.

N/A

N/A

Oklahoma

Does not have a contraceptive equity law.

N/A

N/A

Oregon

 

 

Yes

 

Or. Rev. Stat. § 743A.066(4) http://www.leg.state.or.us/ors/743a.html

 

Religious employers that would not have to provide contraceptive coverage:

  • Churches and associations of churches

 

This religious refusal clause is the same as the religious refusal clause in the health care law.

No protections for consumers working for exempt religious employers.

 

Pennsylvania

Does not have a contraceptive equity law.

N/A

N/A

Rhode Island

 

 

Yes

 

R.I. Gen. Laws § 27-19-48(b)–(d) (hospital service corporation) http://www.rilin.state.ri.us/Statutes/TITLE27/27-19/27-19-48.HTM

 

R.I. Gen. Laws § 27-18-57(b)–(e)   (accident and sickness insurance policy) http://www.rilin.state.ri.us/Statutes/TITLE27/27-18/27-18-57.HTM

 

R.I. Gen. Laws § 27-20-43(b)–(d)  (medical service corporation) http://www.rilin.state.ri.us/Statutes/TITLE27/27-20/27-20-43.HTM

 

R.I. Gen. Laws § 27-41-59(b)–(d) (health maintenance organization) http://www.rilin.state.ri.us/Statutes/TITLE27/27-41/27-41-59.HTM

 

 

Religious employers that would not have to provide contraceptive coverage:

  • Churches and associations of churches
  • Elementary and secondary schools that are controlled, operated, or principally supported by churches and associations of churches
  • Other nonprofit church-affiliated colleges, religious charities, or hospitals that meet certain criteria.

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

The religious employer must provide written notice to prospective enrollees, prior to enrollment, listing the contraceptive health care services the employer refuses to cover.

South Carolina

Does not have a contraceptive equity law.

N/A

N/A

South Dakota

Does not have a contraceptive equity law.

N/A

N/A

Tennessee

Does not have a contraceptive equity law.

N/A

N/A

Texas

Does not have a contraceptive equity law.

N/A

N/A

Utah

Does not have a contraceptive equity law.

N/A

N/A

Vermont

 

 

The contraceptive equity law does not have a religious refusal clause.

N/A

N/A

Virginia

Does not have a contraceptive equity law.

N/A

N/A

Washington

 

 

The administrative rule does not contain any religious refusal clause. Washington state law does contain a provision that permits an employer with a religious or moral tenet opposed to a specific health care service to choose not to purchase insurance coverage for that service if it objects to doing so for reason of conscience or religion, so long as an enrollee is not denied coverage of such service.  Wash. Rev. Code Ann. § 48.43.065 [link to http://apps.leg.wa.gov/rcw/default.aspx?cite=48.43.065]; Wash. Admin. Code § 284-43-800 [link to http://apps.leg.wa.gov/wac/default.aspx?cite=284-43-800].  But the state Attorney General has determined that, in light of the contraceptive coverage rule, this provision does not permit an employer to decline contraceptive coverage for reasons of conscience or religion, noting that while an employer may not be compelled to purchase for its employees coverage to which it has a conscientious objection, it must find a way to cover the costs of contraceptive coverage for its employees.  Wash. A.G.O. 2002 No. 5 (Aug. 8, 2002).

N/A

N/A

West Virginia

Yes

 

W. Va. Code Ann. § 33- 16E-2(5), -7

http://www.legis.state.wv.us/WVCODE/Code.cfm?chap=33&art=16E#16E

 

Religious employers that would not have to provide contraceptive coverage:

  • Churches and associations of churches
  • Elementary and secondary schools that are controlled, operated, or principally supported by churches and associations of churches
  • Other nonprofit church-affiliated colleges or religious charities that meet certain criteria.

 

The law also exempts entities “whose sincerely held religious beliefs or sincerely held moral convictions are central to the employer’s operating principles” and it “is listed in the Official Catholic Directory published by PJ Kennedy and Sons.”

 

This religious refusal clause is broader than the religious refusal clause in the health care law and must be narrowed to align with it.

The health insurer must provide written notice to prospective enrollees listing the services the employer refuses to cover.

 

Must provide coverage for prescription contraceptive methods ordered for reasons other than to prevent unintended pregnancy.

 

The health insurer must make available for purchase a rider that provides prescription contraceptive drugs and devices.

 

Wisconsin

 

 

The contraceptive equity law does not have a religious refusal clause.

N/A

N/A

Wyoming

Does not have a contraceptive equity law.

N/A

N/A