STATE OF NEW JERSEY
218th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2018 SESSION
Sponsored by:
Senator M. TERESA RUIZ
District 29 (Essex)
SYNOPSIS
Requires health insurance coverage for services and drugs related to contraception and reproductive health; repeals conflicting laws.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning contraception and reproductive health, and supplementing various part of the statutory law and repealing P.L.2005, c.251.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A hospital service corporation that provides hospital or medical expense benefits shall provide coverage under every such 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 female contraceptives and all of the following services, drugs, devices, products and procedures:
(1) Well-woman care, including screenings, assessments and counseling.
(2) Pregnancy-related services, including pregnancy tests, preconception care, and prenatal care.
(3) Abortion procedures.
(4) Counseling for sexually transmitted infections, including but not limited to human immunodeficiency virus and acquired immune deficiency syndrome.
(5) Screening for:
(a) chlamydia;
(b) gonorrhea;
(c) hepatitis B;
(d) hepatitis C;
(e) human immunodeficiency virus and acquired immune deficiency syndrome;
(f) human papillomavirus;
(g) syphilis;
(h) anemia;
(i) urinary tract infection;
(j) Rh incompatibility;
(k) gestational diabetes; and
(l) osteoporosis.
(6) Screening for cervical cancer, which coverage shall include expenses incurred for Pap smears, confirmatory tests, and associated laboratory costs as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1995, c.415 (C.17:48E-35.12 et al.).
(7) Screening and appropriate counseling or interventions for:
(a) tobacco use; and
(b) domestic and interpersonal violence.
(8) Folic acid supplements.
(9) Comprehensive breastfeeding support, counseling and supplies.
(10) (a) Screening to determine whether genetic counseling related to the BRCA1 or BRCA2 genetic mutations is indicated;
(b) genetic counseling; and
(c) if indicated, BRCA testing.
(11) Screening for breast cancer, which coverage shall include expenses incurred for mammography examinations as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1991, c.279 (C.17:48-6g et al.).
(12) Breast cancer chemoprevention counseling.
(13) 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 contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested contraceptive drug, device or product or for one or more therapeutic equivalents of the requested drug, device or product.
(b) If a contraceptive drug, device or product is covered but is deemed medically inadvisable by the subscriber’s health care provider, coverage shall be provided for an alternative contraceptive drug, device or product prescribed by the health care provider.
(c) Coverage shall be provided without a prescription for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(d) Coverage shall be provided without any infringement upon a subscriber’s choice of contraception and shall not require prior authorization, step therapy or other utilization management review process for covered contraceptive drugs, devices or other products approved by the United States Food and Drug Administration.
(14) Voluntary sterilization.
(15) Patient education and counseling on contraception.
(16) 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.
(17) 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.
b. (1) A subscriber shall not be charged a deductible, coinsurance, copayment or any other cost-sharing for the coverage required by this section.
(2) A health care provider shall be reimbursed for providing the services described in this section without any deduction for a deductible, coinsurance, copayment, or any other cost-sharing amounts.
c. Except as authorized under this section, a contract shall not impose any restrictions or delays on the coverage required by this section.
d. Coverage shall be provided for the services, drugs, devices, products and procedures required by this section regardless of whether the services, drugs, devices, products and procedures are provided in the course of, or as a follow-up to, other covered services and the cost of the service, drug, device, product or procedure shall be reimbursed separately from any bundled payment for other covered services.
e. This section shall not be construed to exclude coverage for contraceptive drugs, devices or products prescribed by a health care provider, acting within the provider’s scope of practice, for:
(1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
(2) Contraception that is necessary to preserve the life or health of a subscriber.
f. This section shall not be construed to require coverage for:
(1) Experimental or investigational treatments;
(2) Clinical trials or demonstration projects;
(3) Treatments that do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which there is insufficient data to determine efficacy.
g. If services, drugs, devices, products or procedures required by this section are provided under a managed care plan by an out-of-network provider, coverage shall be provided without imposing any cost-sharing requirement on the subscriber if:
(1) There is no in-network provider to furnish the service, drug, device, product or procedure that is geographically accessible or accessible in a reasonable amount of time; or
(2) An in-network provider is unable or unwilling to provide the service, drug, device, product or procedure in a timely manner.
h. A hospital service corporation shall make readily accessible to subscribers and potential subscribers, in a consumer-friendly format, information about the coverage of contraceptives by each contract and the coverage of other services, drugs, devices, products and procedures described in this section. The hospital service corporation shall provide the information:
(1) On its website;
(2) In writing to a subscriber in a summary of benefits and coverage and no later than 14 days after a request by a subscriber; and
(3) In written materials about benefits or coverage that are provided to subscribers and potential subscribers.
i. A religious employer shall request, and a hospital service corporation shall grant, an exclusion for the coverage for contraceptives or abortion procedures required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective subscribers and subscribers. The provisions of this section shall not be construed as authorizing the exclusion of coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of a subscriber. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C.s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C.s.501(c)(3).
j. The benefits required to be covered pursuant to this section shall be provided to the same extent as for any other medical condition under the contract.
k. This section shall apply to those contracts in which the hospital service corporation has reserved the right to change the premium.
2. a. A medical service corporation that provides hospital or medical expense benefits shall provide coverage under every such 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 female contraceptives and all of the following services, drugs, devices, products and procedures:
(1) Well-woman care, including screenings, assessments and counseling.
(2) Pregnancy-related services, including pregnancy tests, preconception care, and prenatal care.
(3) Abortion procedures.
(4) Counseling for sexually transmitted infections, including but not limited to human immunodeficiency virus and acquired immune deficiency syndrome.
(5) Screening for:
(a) chlamydia;
(b) gonorrhea;
(c) hepatitis B;
(d) hepatitis C;
(e) human immunodeficiency virus and acquired immune deficiency syndrome;
(f) human papillomavirus;
(g) syphilis;
(h) anemia;
(i) urinary tract infection;
(j) Rh incompatibility;
(k) gestational diabetes; and
(l) osteoporosis.
(6) Screening for cervical cancer, which coverage shall include expenses incurred for Pap smears, confirmatory tests, and associated laboratory costs as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1995, c.415 (C.17:48E-35.12 et al.).
(7) Screening and appropriate counseling or interventions for:
(a) tobacco use; and
(b) domestic and interpersonal violence.
(8) Folic acid supplements.
(9) Comprehensive breastfeeding support, counseling and supplies.
(10) (a) Screening to determine whether genetic counseling related to the BRCA1 or BRCA2 genetic mutations is indicated;
(b) genetic counseling; and
(c) if indicated, BRCA testing.
(11) Screening for breast cancer, which coverage shall include expenses incurred for mammography examinations as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1991, c.279 (C.17:48-6g et al.).
(12) Breast cancer chemoprevention counseling.
(13) 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 contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested contraceptive drug, device or product or for one or more therapeutic equivalents of the requested drug, device or product.
(b) If a contraceptive drug, device or product is covered but is deemed medically inadvisable by the subscriber’s health care provider, coverage shall be provided for an alternative contraceptive drug, device or product prescribed by the health care provider.
(c) Coverage shall be provided without a prescription for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(d) Coverage shall be provided without any infringement upon a subscriber’s choice of contraception and shall not require prior authorization, step therapy or other utilization management review process for covered contraceptive drugs, devices or other products approved by the United States Food and Drug Administration.
(14) Voluntary sterilization.
(15) Patient education and counseling on contraception.
(16) 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.
(17) 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.
b. (1) A subscriber shall not be charged a deductible, coinsurance, copayment or any other cost-sharing for the coverage required by this section.
(2) A health care provider shall be reimbursed for providing the services described in this section without any deduction for a deductible, coinsurance, copayment, or any other cost-sharing amounts.
c. Except as authorized under this section, a contract shall not impose any restrictions or delays on the coverage required by this section.
d. Coverage shall be provided for the services, drugs, devices, products and procedures required by this section regardless of whether the services, drugs, devices, products and procedures are provided in the course of, or as a follow-up to, other covered services and the cost of the service, drug, device, product or procedure shall be reimbursed separately from any bundled payment for other covered services.
e. This section shall not be construed to exclude coverage for contraceptive drugs, devices or products prescribed by a health care provider, acting within the provider’s scope of practice, for:
(1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
(2) Contraception that is necessary to preserve the life or health of a subscriber.
f. This section shall not be construed to require coverage for:
(1) Experimental or investigational treatments;
(2) Clinical trials or demonstration projects;
(3) Treatments that do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which there is insufficient data to determine efficacy.
g. If services, drugs, devices, products or procedures required by this section are provided under a managed care plan by an out-of-network provider, coverage shall be provided without imposing any cost-sharing requirement on the subscriber if:
(1) There is no in-network provider to furnish the service, drug, device, product or procedure that is geographically accessible or accessible in a reasonable amount of time; or
(2) An in-network provider is unable or unwilling to provide the service, drug, device, product or procedure in a timely manner.
h. A medical service corporation shall make readily accessible to subscribers and potential subscribers, in a consumer-friendly format, information about the coverage of contraceptives by each contract and the coverage of other services, drugs, devices, products and procedures described in this section. The hospital service corporation shall provide the information:
(1) On its website;
(2) In writing to a subscriber in a summary of benefits and coverage and no later than 14 days after a request by a subscriber; and
(3) In written materials about benefits or coverage that are provided to subscribers and potential subscribers.
i. A religious employer shall request, and a medical service corporation shall grant, an exclusion for the coverage for contraceptives or abortion procedures required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective subscribers and subscribers. The provisions of this section shall not be construed as authorizing the exclusion of coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of a subscriber. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C.s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C.s.501(c)(3).
j. The benefits required to be covered pursuant to this section shall be provided to the same extent as for any other medical condition under the contract.
k. This section shall apply to those contracts in which the medical service corporation has reserved the right to change the premium.
3. a. A health service corporation that provides hospital or medical expense benefits shall provide coverage under every such 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 female contraceptives and all of the following services, drugs, devices, products and procedures:
(1) Well-woman care, including screenings, assessments and counseling.
(2) Pregnancy-related services, including pregnancy tests, preconception care, and prenatal care.
(3) Abortion procedures.
(4) Counseling for sexually transmitted infections, including but not limited to human immunodeficiency virus and acquired immune deficiency syndrome.
(5) Screening for:
(a) chlamydia;
(b) gonorrhea;
(c) hepatitis B;
(d) hepatitis C;
(e) human immunodeficiency virus and acquired immune deficiency syndrome;
(f) human papillomavirus;
(g) syphilis;
(h) anemia;
(i) urinary tract infection;
(j) Rh incompatibility;
(k) gestational diabetes; and
(l) osteoporosis.
(6) Screening for cervical cancer, which coverage shall include expenses incurred for Pap smears, confirmatory tests, and associated laboratory costs as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1995, c.415 (C.17:48E-35.12 et al.).
(7) Screening and appropriate counseling or interventions for:
(a) tobacco use; and
(b) domestic and interpersonal violence.
(8) Folic acid supplements.
(9) Comprehensive breastfeeding support, counseling and supplies.
(10) (a) Screening to determine whether genetic counseling related to the BRCA1 or BRCA2 genetic mutations is indicated;
(b) genetic counseling; and
(c) if indicated, BRCA testing.
(11) Screening for breast cancer, which coverage shall include expenses incurred for mammography examinations as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1991, c.279 (C.17:48-6g et al.).
(12) Breast cancer chemoprevention counseling.
(13) 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 contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested contraceptive drug, device or product or for one or more therapeutic equivalents of the requested drug, device or product.
(b) If a contraceptive drug, device or product is covered but is deemed medically inadvisable by the subscriber’s health care provider, coverage shall be provided for an alternative contraceptive drug, device or product prescribed by the health care provider.
(c) Coverage shall be provided without a prescription for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(d) Coverage shall be provided without any infringement upon a subscriber’s choice of contraception and shall not require prior authorization, step therapy or other utilization management review process for covered contraceptive drugs, devices or other products approved by the United States Food and Drug Administration.
(14) Voluntary sterilization.
(15) Patient education and counseling on contraception.
(16) 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.
(17) 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.
b. (1) A subscriber shall not be charged a deductible, coinsurance, copayment or any other cost-sharing for the coverage required by this section.
(2) A health care provider shall be reimbursed for providing the services described in this section without any deduction for a deductible, coinsurance, copayment, or any other cost-sharing amounts.
c. Except as authorized under this section, a contract shall not impose any restrictions or delays on the coverage required by this section.
d. Coverage shall be provided for the services, drugs, devices, products and procedures required by this section regardless of whether the services, drugs, devices, products and procedures are provided in the course of, or as a follow-up to, other covered services and the cost of the service, drug, device, product or procedure shall be reimbursed separately from any bundled payment for other covered services.
e. This section shall not be construed to exclude coverage for contraceptive drugs, devices or products prescribed by a health care provider, acting within the provider’s scope of practice, for:
(1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
(2) Contraception that is necessary to preserve the life or health of a subscriber.
f. This section shall not be construed to require coverage for:
(1) Experimental or investigational treatments;
(2) Clinical trials or demonstration projects;
(3) Treatments that do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which there is insufficient data to determine efficacy.
g. If services, drugs, devices, products or procedures required by this section are provided under a managed care plan by an out-of-network provider, coverage shall be provided without imposing any cost-sharing requirement on the subscriber if:
(1) There is no in-network provider to furnish the service, drug, device, product or procedure that is geographically accessible or accessible in a reasonable amount of time; or
(2) An in-network provider is unable or unwilling to provide the service, drug, device, product or procedure in a timely manner.
h. A health service corporation shall make readily accessible to subscribers and potential subscribers, in a consumer-friendly format, information about the coverage of contraceptives by each contract and the coverage of other services, drugs, devices, products and procedures described in this section. The health service corporation shall provide the information:
(1) On its website;
(2) In writing to a subscriber in a summary of benefits and coverage and no later than 14 days after a request by a subscriber; and
(3) In written materials about benefits or coverage that are provided to subscribers and potential subscribers.
i. A religious employer shall request, and a health service corporation shall grant, an exclusion for the coverage for contraceptives or abortion procedures required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective subscribers and subscribers. The provisions of this section shall not be construed as authorizing the exclusion of coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of a subscriber. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C.s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C.s.501(c)(3).
j. The benefits required to be covered pursuant to this section shall be provided to the same extent as for any other medical condition under the contract.
k. This section shall apply to those contracts in which the health service corporation has reserved the right to change the premium.
4. a. An individual health insurer that provides hospital or medical expense benefits shall provide coverage under every such policy 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 female contraceptives and all of the following services, drugs, devices, products and procedures:
(1) Well-woman care, including screenings, assessments and counseling.
(2) Pregnancy-related services, including pregnancy tests, preconception care, and prenatal care.
(3) Abortion procedures.
(4) Counseling for sexually transmitted infections, including but not limited to human immunodeficiency virus and acquired immune deficiency syndrome.
(5) Screening for:
(a) chlamydia;
(b) gonorrhea;
(c) hepatitis B;
(d) hepatitis C;
(e) human immunodeficiency virus and acquired immune deficiency syndrome;
(f) human papillomavirus;
(g) syphilis;
(h) anemia;
(i) urinary tract infection;
(j) Rh incompatibility;
(k) gestational diabetes; and
(l) osteoporosis.
(6) Screening for cervical cancer, which coverage shall include expenses incurred for Pap smears, confirmatory tests, and associated laboratory costs as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1995, c.415 (C.17:48E-35.12 et al.).
(7) Screening and appropriate counseling or interventions for:
(a) tobacco use; and
(b) domestic and interpersonal violence.
(8) Folic acid supplements.
(9) Comprehensive breastfeeding support, counseling and supplies.
(10) (a) Screening to determine whether genetic counseling related to the BRCA1 or BRCA2 genetic mutations is indicated;
(b) genetic counseling; and
(c) if indicated, BRCA testing.
(11) Screening for breast cancer, which coverage shall include expenses incurred for mammography examinations as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1991, c.279 (C.17:48-6g et al.).
(12) Breast cancer chemoprevention counseling.
(13) 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 contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested contraceptive drug, device or product or for one or more therapeutic equivalents of the requested drug, device or product.
(b) If a contraceptive drug, device or product is covered but is deemed medically inadvisable by the insured’s health care provider, coverage shall be provided for an alternative contraceptive drug, device or product prescribed by the health care provider.
(c) Coverage shall be provided without a prescription for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(d) Coverage shall be provided without any infringement upon an insured’s choice of contraception and shall not require prior authorization, step therapy or other utilization management review process for covered contraceptive drugs, devices or other products approved by the United States Food and Drug Administration.
(14) Voluntary sterilization.
(15) Patient education and counseling on contraception.
(16) 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 insured’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.
(17) 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.
b. (1) An insured shall not be charged a deductible, coinsurance, copayment or any other cost-sharing for the coverage required by this section.
(2) A health care provider shall be reimbursed for providing the services described in this section without any deduction for a deductible, coinsurance, copayment, or any other cost-sharing amounts.
c. Except as authorized under this section, a policy shall not impose any restrictions or delays on the coverage required by this section.
d. Coverage shall be provided for the services, drugs, devices, products and procedures required by this section regardless of whether the services, drugs, devices, products and procedures are provided in the course of, or as a follow-up to, other covered services and the cost of the service, drug, device, product or procedure shall be reimbursed separately from any bundled payment for other covered services.
e. This section shall not be construed to exclude coverage for contraceptive drugs, devices or products prescribed by a health care provider, acting within the provider’s scope of practice, for:
(1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
(2) Contraception that is necessary to preserve the life or health of an insured.
f. This section shall not be construed to require coverage for:
(1) Experimental or investigational treatments;
(2) Clinical trials or demonstration projects;
(3) Treatments that do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which there is insufficient data to determine efficacy.
g. If services, drugs, devices, products or procedures required by this section are provided under a managed care plan by an out-of-network provider, coverage shall be provided without imposing any cost-sharing requirement on the insured if:
(1) There is no in-network provider to furnish the service, drug, device, product or procedure that is geographically accessible or accessible in a reasonable amount of time; or
(2) An in-network provider is unable or unwilling to provide the service, drug, device, product or procedure in a timely manner.
h. An individual health insurer shall make readily accessible to insureds and potential insureds, in a consumer-friendly format, information about the coverage of contraceptives by each policy and the coverage of other services, drugs, devices, products and procedures described in this section. The insurer shall provide the information:
(1) On its website;
(2) In writing to an insured in a summary of benefits and coverage and no later than 14 days after a request by a subscriber; and
(3) In written materials about benefits or coverage that are provided to insureds and potential insureds.
i. A religious employer shall request, and an individual health insurer shall grant, an exclusion for the coverage for contraceptives or abortion procedures required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective insureds and insureds. The provisions of this section shall not be construed as authorizing the exclusion of coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of an insured. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C.s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C.s.501(c)(3).
j. The benefits required to be covered pursuant to this section shall be provided to the same extent as for any other medical condition under the policy.
k. This section shall apply to those policies in which the individual health insurer has reserved the right to change the premium.
5. a. A group health insurer that provides hospital or medical expense benefits shall provide coverage under every such policy 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 female contraceptives and all of the following services, drugs, devices, products and procedures:
(1) Well-woman care, including screenings, assessments and counseling.
(2) Pregnancy-related services, including pregnancy tests, preconception care, and prenatal care.
(3) Abortion procedures.
(4) Counseling for sexually transmitted infections, including but not limited to human immunodeficiency virus and acquired immune deficiency syndrome.
(5) Screening for:
(a) chlamydia;
(b) gonorrhea;
(c) hepatitis B;
(d) hepatitis C;
(e) human immunodeficiency virus and acquired immune deficiency syndrome;
(f) human papillomavirus;
(g) syphilis;
(h) anemia;
(i) urinary tract infection;
(j) Rh incompatibility;
(k) gestational diabetes; and
(l) osteoporosis.
(6) Screening for cervical cancer, which coverage shall include expenses incurred for Pap smears, confirmatory tests, and associated laboratory costs as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1995, c.415 (C.17:48E-35.12 et al.).
(7) Screening and appropriate counseling or interventions for:
(a) tobacco use; and
(b) domestic and interpersonal violence.
(8) Folic acid supplements.
(9) Comprehensive breastfeeding support, counseling and supplies.
(10) (a) Screening to determine whether genetic counseling related to the BRCA1 or BRCA2 genetic mutations is indicated;
(b) genetic counseling; and
(c) if indicated, BRCA testing.
(11) Screening for breast cancer, which coverage shall include expenses incurred for mammography examinations as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1991, c.279 (C.17:48-6g et al.).
(12) Breast cancer chemoprevention counseling.
(13) 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 contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested contraceptive drug, device or product or for one or more therapeutic equivalents of the requested drug, device or product.
(b) If a contraceptive drug, device or product is covered but is deemed medically inadvisable by the insured’s health care provider, coverage shall be provided for an alternative contraceptive drug, device or product prescribed by the health care provider.
(c) Coverage shall be provided without a prescription for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(d) Coverage shall be provided without any infringement upon an insured’s choice of contraception and shall not require prior authorization, step therapy or other utilization management review process for covered contraceptive drugs, devices or other products approved by the United States Food and Drug Administration.
(14) Voluntary sterilization.
(15) Patient education and counseling on contraception.
(16) 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 insured’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.
(17) 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.
b. (1) An insured shall not be charged a deductible, coinsurance, copayment or any other cost-sharing for the coverage required by this section.
(2) A health care provider shall be reimbursed for providing the services described in this section without any deduction for a deductible, coinsurance, copayment, or any other cost-sharing amounts.
c. Except as authorized under this section, a policy shall not impose any restrictions or delays on the coverage required by this section.
d. Coverage shall be provided for the services, drugs, devices, products and procedures required by this section regardless of whether the services, drugs, devices, products and procedures are provided in the course of, or as a follow-up to, other covered services and the cost of the service, drug, device, product or procedure shall be reimbursed separately from any bundled payment for other covered services.
e. This section shall not be construed to exclude coverage for contraceptive drugs, devices or products prescribed by a health care provider, acting within the provider’s scope of practice, for:
(1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
(2) Contraception that is necessary to preserve the life or health of an insured.
f. This section shall not be construed to require coverage for:
(1) Experimental or investigational treatments;
(2) Clinical trials or demonstration projects;
(3) Treatments that do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which there is insufficient data to determine efficacy.
g. If services, drugs, devices, products or procedures required by this section are provided under a managed care plan by an out-of-network provider, coverage shall be provided without imposing any cost-sharing requirement on the insured if:
(1) There is no in-network provider to furnish the service, drug, device, product or procedure that is geographically accessible or accessible in a reasonable amount of time; or
(2) An in-network provider is unable or unwilling to provide the service, drug, device, product or procedure in a timely manner.
h. A group health insurer shall make readily accessible to insureds and potential insureds, in a consumer-friendly format, information about the coverage of contraceptives by each policy and the coverage of other services, drugs, devices, products and procedures described in this section. The group health insurer shall provide the information:
(1) On its website;
(2) In writing to an insured in a summary of benefits and coverage and no later than 14 days after a request by an insured; and
(3) In written materials about benefits or coverage that are provided to insureds and potential insureds.
i. A religious employer shall request, and a group health insurer shall grant, an exclusion for the coverage for contraceptives or abortion procedures required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective insureds and insureds. The provisions of this section shall not be construed as authorizing the exclusion of coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of an insured. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C.s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C.s.501(c)(3).
j. The benefits required to be covered pursuant to this section shall be provided to the same extent as for any other medical condition under the policy.
k. This section shall apply to those policies in which the group health insurer has reserved the right to change the premium.
6. (New section) a. An individual health benefits plan that provides hospital or medical expense benefits shall provide coverage under every such plan 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 for expenses incurred in the purchase of prescription female contraceptives and all of the following services, drugs, devices, products and procedures:
(1) Well-woman care, including screenings, assessments and counseling.
(2) Pregnancy-related services, including pregnancy tests, preconception care, and prenatal care.
(3) Abortion procedures.
(4) Counseling for sexually transmitted infections, including but not limited to human immunodeficiency virus and acquired immune deficiency syndrome.
(5) Screening for:
(a) chlamydia;
(b) gonorrhea;
(c) hepatitis B;
(d) hepatitis C;
(e) human immunodeficiency virus and acquired immune deficiency syndrome;
(f) human papillomavirus;
(g) syphilis;
(h) anemia;
(i) urinary tract infection;
(j) Rh incompatibility;
(k) gestational diabetes; and
(l) osteoporosis.
(6) Screening for cervical cancer, which coverage shall include expenses incurred for Pap smears, confirmatory tests, and associated laboratory costs as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1995, c.415 (C.17:48E-35.12 et al.).
(7) Screening and appropriate counseling or interventions for:
(a) tobacco use; and
(b) domestic and interpersonal violence.
(8) Folic acid supplements.
(9) Comprehensive breastfeeding support, counseling and supplies.
(10) (a) Screening to determine whether genetic counseling related to the BRCA1 or BRCA2 genetic mutations is indicated;
(b) genetic counseling; and
(c) if indicated, BRCA testing.
(11) Screening for breast cancer, which coverage shall include expenses incurred for mammography examinations as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1991, c.279 (C.17:48-6g et al.).
(12) Breast cancer chemoprevention counseling.
(13) 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 contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested contraceptive drug, device or product or for one or more therapeutic equivalents of the requested drug, device or product.
(b) If a contraceptive drug, device or product is covered but is deemed medically inadvisable by the covered person’s health care provider, coverage shall be provided for an alternative contraceptive drug, device or product prescribed by the health care provider.
(c) Coverage shall be provided without a prescription for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(d) Coverage shall be provided without any infringement upon a covered person’s choice of contraception and shall not require prior authorization, step therapy or other utilization management review process for covered contraceptive drugs, devices or other products approved by the United States Food and Drug Administration.
(14) Voluntary sterilization.
(15) Patient education and counseling on contraception.
(16) 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 covered person’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.
(17) 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.
b. (1) A covered person shall not be charged a deductible, coinsurance, copayment or any other cost-sharing for the coverage required by this section.
(2) A health care provider shall be reimbursed for providing the services described in this section without any deduction for a deductible, coinsurance, copayment, or any other cost-sharing amounts.
c. Except as authorized under this section, a contract shall not impose any restrictions or delays on the coverage required by this section.
d. Coverage shall be provided for the services, drugs, devices, products and procedures required by this section regardless of whether the services, drugs, devices, products and procedures are provided in the course of, or as a follow-up to, other covered services and the cost of the service, drug, device, product or procedure shall be reimbursed separately from any bundled payment for other covered services.
e. This section shall not be construed to exclude coverage for contraceptive drugs, devices or products prescribed by a health care provider, acting within the provider’s scope of practice, for:
(1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
(2) Contraception that is necessary to preserve the life or health of a covered person.
f. This section shall not be construed to require coverage for:
(1) Experimental or investigational treatments;
(2) Clinical trials or demonstration projects;
(3) Treatments that do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which there is insufficient data to determine efficacy.
g. If services, drugs, devices, products or procedures required by this section are provided under a managed care plan by an out-of-network provider, coverage shall be provided without imposing any cost-sharing requirement on the covered person if:
(1) There is no in-network provider to furnish the service, drug, device, product or procedure that is geographically accessible or accessible in a reasonable amount of time; or
(2) An in-network provider is unable or unwilling to provide the service, drug, device, product or procedure in a timely manner.
h. A carrier shall make readily accessible to covered persons and potential covered persons, in a consumer-friendly format, information about the coverage of contraceptives by each contract and the coverage of other services, drugs, devices, products and procedures described in this section. The carrier shall provide the information:
(1) On its website;
(2) In writing to a covered person in a summary of benefits and coverage and no later than 14 days after a request by a covered person; and
(3) In written materials about benefits or coverage that are provided to covered persons and potential covered persons.
i. A religious employer shall request, and a carrier shall grant, an exclusion for the coverage for contraceptives or abortion procedures required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective covered persons and covered persons. The provisions of this section shall not be construed as authorizing the exclusion of coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of a covered person. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C.s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C.s.501(c)(3).
j. The benefits required to be covered pursuant to this section shall be provided to the same extent as for any other medical condition under the health benefits plan.
k. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
7. a. A small employer health benefits plan that provides hospital or medical expense benefits shall provide coverage under every such plan 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 female contraceptives and all of the following services, drugs, devices, products and procedures:
(1) Well-woman care, including screenings, assessments and counseling.
(2) Pregnancy-related services, including pregnancy tests, preconception care, and prenatal care.
(3) Abortion procedures.
(4) Counseling for sexually transmitted infections, including but not limited to human immunodeficiency virus and acquired immune deficiency syndrome.
(5) Screening for:
(a) chlamydia;
(b) gonorrhea;
(c) hepatitis B;
(d) hepatitis C;
(e) human immunodeficiency virus and acquired immune deficiency syndrome;
(f) human papillomavirus;
(g) syphilis;
(h) anemia;
(i) urinary tract infection;
(j) Rh incompatibility;
(k) gestational diabetes; and
(l) osteoporosis.
(6) Screening for cervical cancer, which coverage shall include expenses incurred for Pap smears, confirmatory tests, and associated laboratory costs as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1995, c.415 (C.17:48E-35.12 et al.).
(7) Screening and appropriate counseling or interventions for:
(a) tobacco use; and
(b) domestic and interpersonal violence.
(8) Folic acid supplements.
(9) Comprehensive breastfeeding support, counseling and supplies.
(10) (a) Screening to determine whether genetic counseling related to the BRCA1 or BRCA2 genetic mutations is indicated;
(b) genetic counseling; and
(c) if indicated, BRCA testing.
(11) Screening for breast cancer, which coverage shall include expenses incurred for mammography examinations as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1991, c.279 (C.17:48-6g et al.).
(12) Breast cancer chemoprevention counseling.
(13) 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 contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested contraceptive drug, device or product or for one or more therapeutic equivalents of the requested drug, device or product.
(b) If a contraceptive drug, device or product is covered but is deemed medically inadvisable by the covered person’s health care provider, coverage shall be provided for an alternative contraceptive drug, device or product prescribed by the health care provider.
(c) Coverage shall be provided without a prescription for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(d) Coverage shall be provided without any infringement upon a covered person’s choice of contraception and shall not require prior authorization, step therapy or other utilization management review process for covered contraceptive drugs, devices or other products approved by the United States Food and Drug Administration.
(14) Voluntary sterilization.
(15) Patient education and counseling on contraception.
(16) 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 covered person’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.
(17) 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.
b. (1) A health care provider shall not be charged a deductible, coinsurance, copayment or any other cost-sharing for the coverage required by this section.
(2) A health care provider shall be reimbursed for providing the services described in this section without any deduction for a deductible, coinsurance, copayment, or any other cost-sharing amounts.
c. Except as authorized under this section, a contract shall not impose any restrictions or delays on the coverage required by this section.
d. Coverage shall be provided for the services, drugs, devices, products and procedures required by this section regardless of whether the services, drugs, devices, products and procedures are provided in the course of, or as a follow-up to, other covered services and the cost of the service, drug, device, product or procedure shall be reimbursed separately from any bundled payment for other covered services.
e. This section shall not be construed to exclude coverage for contraceptive drugs, devices or products prescribed by a health care provider, acting within the provider’s scope of practice, for:
(1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
(2) Contraception that is necessary to preserve the life or health of a covered person.
f. This section shall not be construed to require coverage for:
(1) Experimental or investigational treatments;
(2) Clinical trials or demonstration projects;
(3) Treatments that do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which there is insufficient data to determine efficacy.
g. If services, drugs, devices, products or procedures required by this section are provided under a managed care plan by an out-of-network provider, coverage shall be provided without imposing any cost-sharing requirement on the covered person if:
(1) There is no in-network provider to furnish the service, drug, device, product or procedure that is geographically accessible or accessible in a reasonable amount of time; or
(2) An in-network provider is unable or unwilling to provide the service, drug, device, product or procedure in a timely manner.
h. A carrier shall make readily accessible to covered persons and potential covered persons, in a consumer-friendly format, information about the coverage of contraceptives by each contract and the coverage of other services, drugs, devices, products and procedures described in this section. The carrier shall provide the information:
(1) On its website;
(2) In writing to a covered person in a summary of benefits and coverage and no later than 14 days after a request by a covered person; and
(3) In written materials about benefits or coverage that are provided to covered persons and potential covered persons.
i. A religious employer shall request, and a carrier shall grant, an exclusion for the coverage for contraceptives or abortion procedures required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective covered persons and covered persons. The provisions of this section shall not be construed as authorizing the exclusion of coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of a covered person. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C.s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C.s.501(c)(3).
j. The benefits required to be covered pursuant to this section shall be provided to the same extent as for any other medical condition under the health benefits plan.
k. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
8. a. A health maintenance organization that provides hospital or medical expense benefits shall provide coverage under every such 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 female contraceptives and all of the following services, drugs, devices, products and procedures:
(1) Well-woman care, including screenings, assessments and counseling.
(2) Pregnancy-related services, including pregnancy tests, preconception care, and prenatal care.
(3) Abortion procedures.
(4) Counseling for sexually transmitted infections, including but not limited to human immunodeficiency virus and acquired immune deficiency syndrome.
(5) Screening for:
(a) chlamydia;
(b) gonorrhea;
(c) hepatitis B;
(d) hepatitis C;
(e) human immunodeficiency virus and acquired immune deficiency syndrome;
(f) human papillomavirus;
(g) syphilis;
(h) anemia;
(i) urinary tract infection;
(j) Rh incompatibility;
(k) gestational diabetes; and
(l) osteoporosis.
(6) Screening for cervical cancer, which coverage shall include expenses incurred for Pap smears, confirmatory tests, and associated laboratory costs as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1995, c.415 (C.17:48E-35.12 et al.).
(7) Screening and appropriate counseling or interventions for:
(a) tobacco use; and
(b) domestic and interpersonal violence.
(8) Folic acid supplements.
(9) Comprehensive breastfeeding support, counseling and supplies.
(10) (a) Screening to determine whether genetic counseling related to the BRCA1 or BRCA2 genetic mutations is indicated;
(b) genetic counseling; and
(c) if indicated, BRCA testing.
(11) Screening for breast cancer, which coverage shall include expenses incurred for mammography examinations as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1991, c.279 (C.17:48-6g et al.).
(12) Breast cancer chemoprevention counseling.
(13) 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 contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested contraceptive drug, device or product or for one or more therapeutic equivalents of the requested drug, device or product.
(b) If a contraceptive drug, device or product is covered but is deemed medically inadvisable by the enrollee’s health care provider, coverage shall be provided for an alternative contraceptive drug, device or product prescribed by the health care provider.
(c) Coverage shall be provided without a prescription for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(d) Coverage shall be provided without any infringement upon a enrollee’s choice of contraception and shall not require prior authorization, step therapy or other utilization management review process for covered contraceptive drugs, devices or other products approved by the United States Food and Drug Administration.
(14) Voluntary sterilization.
(15) Patient education and counseling on contraception.
(16) 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 enrollee’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.
(17) 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.
b. (1) An enrollee shall not be charged a deductible, coinsurance, copayment or any other cost-sharing for the coverage required by this section.
(2) A health care provider shall be reimbursed for providing the services described in this section without any deduction for a deductible, coinsurance, copayment, or any other cost-sharing amounts.
c. Except as authorized under this section, an enrollee shall not impose any restrictions or delays on the coverage required by this section.
d. Coverage shall be provided for the services, drugs, devices, products and procedures required by this section regardless of whether the services, drugs, devices, products and procedures are provided in the course of, or as a follow-up to, other covered services and the cost of the service, drug, device, product or procedure shall be reimbursed separately from any bundled payment for other covered services.
e. This section shall not be construed to exclude coverage for contraceptive drugs, devices or products prescribed by a health care provider, acting within the provider’s scope of practice, for:
(1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
(2) Contraception that is necessary to preserve the life or health of a enrollee.
f. This section shall not be construed to require coverage for:
(1) Experimental or investigational treatments;
(2) Clinical trials or demonstration projects;
(3) Treatments that do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which there is insufficient data to determine efficacy.
g. If services, drugs, devices, products or procedures required by this section are provided under a managed care plan by an out-of-network provider, coverage shall be provided without imposing any cost-sharing requirement on the enrollee if:
(1) There is no in-network provider to furnish the service, drug, device, product or procedure that is geographically accessible or accessible in a reasonable amount of time; or
(2) An in-network provider is unable or unwilling to provide the service, drug, device, product or procedure in a timely manner.
h. A health maintenance organization shall make readily accessible to enrollees and potential enrollees, in a consumer-friendly format, information about the coverage of contraceptives by each contract and the coverage of other services, drugs, devices, products and procedures described in this section. The health maintenance organization shall provide the information:
(1) On its website;
(2) In writing to an enrollee in a summary of benefits and coverage and no later than 14 days after a request by an enrollee; and
(3) In written materials about benefits or coverage that are provided to enrollees and potential enrollees.
i. A religious employer shall request, and a health maintenance organization shall grant, an exclusion for the coverage for contraceptives or abortion procedures required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective enrollees and enrollees. The provisions of this section shall not be construed as authorizing the exclusion of coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of an enrollee. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C.s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C.s.501(c)(3).
j. The benefits required to be covered pursuant to this section shall be provided to the same extent as for any other medical condition under the contract.
k. This section shall apply to those contracts in which the health maintenance organization has reserved the right to change the premium.
9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act shall provide coverage for expenses incurred in the purchase of prescription female contraceptives and all of the following services, drugs, devices, products and procedures:
(1) Well-woman care, including screenings, assessments and counseling.
(2) Pregnancy-related services, including pregnancy tests, preconception care, and prenatal care.
(3) Abortion procedures.
(4) Counseling for sexually transmitted infections, including but not limited to human immunodeficiency virus and acquired immune deficiency syndrome.
(5) Screening for:
(a) chlamydia;
(b) gonorrhea;
(c) hepatitis B;
(d) hepatitis C;
(e) human immunodeficiency virus and acquired immune deficiency syndrome;
(f) human papillomavirus;
(g) syphilis;
(h) anemia;
(i) urinary tract infection;
(j) Rh incompatibility;
(k) gestational diabetes; and
(l) osteoporosis.
(6) Screening for cervical cancer, which coverage shall include expenses incurred for Pap smears, confirmatory tests, and associated laboratory costs as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1995, c.415 (C.17:48E-35.12 et al.).
(7) Screening and appropriate counseling or interventions for:
(a) tobacco use; and
(b) domestic and interpersonal violence.
(8) Folic acid supplements.
(9) Comprehensive breastfeeding support, counseling and supplies.
(10) (a) Screening to determine whether genetic counseling related to the BRCA1 or BRCA2 genetic mutations is indicated;
(b) genetic counseling; and
(c) if indicated, BRCA testing.
(11) Screening for breast cancer, which coverage shall include expenses incurred for mammography examinations as required to be provided by certain health benefits policies, contracts, and plans pursuant to the provisions of P.L.1991, c.279 (C.17:48-6g et al.).
(12) Breast cancer chemoprevention counseling.
(13) 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 contraceptive drug, device or product approved by the United States Food and Drug Administration, coverage shall be provided for either the requested contraceptive drug, device or product or for one or more therapeutic equivalents of the requested drug, device or product.
(b) If a contraceptive drug, device or product is covered but is deemed medically inadvisable by the covered person’s health care provider, coverage shall be provided for an alternative contraceptive drug, device or product prescribed by the health care provider.
(c) Coverage shall be provided without a prescription for all contraceptive drugs available for over-the-counter sale that are approved by the United States Food and Drug Administration.
(d) Coverage shall be provided without any infringement upon a covered person’s choice of contraception and shall not require prior authorization, step therapy or other utilization management review process for covered contraceptive drugs, devices or other products approved by the United States Food and Drug Administration.
(14) Voluntary sterilization.
(15) Patient education and counseling on contraception.
(16) 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 covered person’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.
(17) 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.
b. (1) A covered person shall not be charged a deductible, coinsurance, copayment or any other cost-sharing for the coverage required by this section.
(2) A health care provider shall be reimbursed for providing the services described in this section without any deduction for a deductible, coinsurance, copayment, or any other cost-sharing amounts.
c. Except as authorized under this section, a contract shall not impose any restrictions or delays on the coverage required by this section.
d. Coverage shall be provided for the services, drugs, devices, products and procedures required by this section regardless of whether the services, drugs, devices, products and procedures are provided in the course of, or as a follow-up to, other covered services and the cost of the service, drug, device, product or procedure shall be reimbursed separately from any bundled payment for other covered services.
e. This section shall not be construed to exclude coverage for contraceptive drugs, devices or products prescribed by a health care provider, acting within the provider’s scope of practice, for:
(1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
(2) Contraception that is necessary to preserve the life or health of a covered person.
f. This section shall not be construed to require coverage for:
(1) Experimental or investigational treatments;
(2) Clinical trials or demonstration projects;
(3) Treatments that do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which there is insufficient data to determine efficacy.
g. If services, drugs, devices, products or procedures required by this section are provided under a managed care plan by an out-of-network provider, coverage shall be provided without imposing any cost-sharing requirement on the covered person if:
(1) There is no in-network provider to furnish the service, drug, device, product or procedure that is geographically accessible or accessible in a reasonable amount of time; or
(2) An in-network provider is unable or unwilling to provide the service, drug, device, product or procedure in a timely manner.
h. The carrier shall make readily accessible to covered persons and potential covered persons, in a consumer-friendly format, information about the coverage of contraceptives by each contract and the coverage of other services, drugs, devices, products and procedures described in this section. The carrier shall provide the information:
(1) On its website;
(2) In writing to a covered person in a summary of benefits and coverage and no later than 14 days after a request by a subscriber; and
(3) In written materials about benefits or coverage that are provided to covered persons and potential covered persons.
10. a. A prepaid prescription service organization that provides benefits for expenses incurred in the purchase of outpatient prescription drugs under a contract shall provide coverage under every such 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 female contraceptives and the services, drugs, devices, products, and procedures as determined to be required to be covered by the Commissioner of Banking and Insurance pursuant to subsection b. of this section.
b. The Commissioner of Banking and Insurance shall determine, in the commissioner’s discretion, which provisions of the coverage requirements applicable to insurers in sections 1 through 10 of P.L. , c. (C. ) (pending before the Legislature as this bill,) shall apply to prepaid prescription organizations, and shall adopt regulations in accordance with the commissioner’s determination.
c. A religious employer may request, and a prepaid prescription service organization shall grant, an exclusion under the contract for the coverage required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective enrollees and enrollees. The provisions of this section shall not be construed as authorizing a prepaid prescription service organization to exclude coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of an enrollee. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C.s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C.s.501(c)(3).
d. The benefits required to be covered pursuant to this section shall be provided to the same extent as for any other outpatient prescription drug under the contract.
e. This section shall apply to those prepaid prescription contracts in which the prepaid prescription service organization has reserved the right to change the premium.
11. a. An individual shall not, on the basis of actual or perceived race, color, national origin, sex, sexual orientation, gender identity, age or disability, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination with respect to any contract, policy, or plan of health insurance issued or delivered in this State in the coverage of or payment for the services, drugs, devices, products and procedures described in sections 1 through 10 of P.L. , c. (C. )(pending before the Legislature as this bill).
b. A violation of this section by any person shall be a violation of the New Jersey “Law Against Discrimination,” P.L.1945, c.169 (C.10:5-1 et seq.).
12. P.L.2005, c.251 (C.17:48-6ee et al.) is repealed.
13. This act shall take
effect on the 90th day next following enactment.
STATEMENT
This bill requires health insurance coverage for a comprehensive list of services, drugs, screenings, and counseling, related to contraception and reproductive health. The bill requires health insurers, the State Health Benefits Program, and the School Employees’ Health Benefits Program to adhere to certain coverage requirements with respect to these services.
The bill prohibits charging a deductible, coinsurance, copayment, or any other cost-sharing mechanism to the insured for the coverage required by the bill.
The bill shall not be construed to exclude coverage for contraceptive drugs, devices or products prescribed by a health care provider, acting within the provider’s scope of practice, for:
(1) Reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause; or
(2) Contraception that is necessary to preserve the life or health of an insured.
The bill shall not be construed to require coverage for:
(1) Experimental or investigational treatments;
(2) Clinical trials or demonstration projects;
(3) Treatments that do not conform to acceptable and customary standards of medical practice; or
(4) Treatments for which there is insufficient data to determine efficacy.
The bill provides that if services, drugs, devices, products or procedures are provided under a managed care plan by an out-of-network provider, coverage shall be provided without imposing any cost-sharing requirement on the insured and shall be covered at an in-network rate under certain circumstances.
The bill requires insurers to make readily accessible to insureds and potential insureds, in a consumer-friendly format, information about the coverage of contraceptives by each contract or policy and the coverage of other services, drugs, devices, products and procedures described in this bill.
The bill provides that a prepaid prescription service organization that provides benefits for expenses incurred in the purchase of outpatient prescription drugs under a contract shall provide coverage under every such contract for expenses incurred in the purchase of prescription female contraceptives. The bill also provides that the Commissioner of Banking and Insurance shall determine, in the commissioner’s discretion, which provisions of the coverage requirements applicable to insurers in the bill shall apply to prepaid prescription organizations, and the commissioner shall adopt regulations in accordance with that determination.
The bill provides that a religious employer shall request, and an insurer shall grant, an exclusion for the coverage for contraceptives or abortion procedures required by this bill if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective insureds and insureds. This provision shall not be construed as authorizing an insurer to exclude coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of an insured.
The bill repeals statutes, initially enacted in 2005, which required coverage for the treatment of prescription female contraceptives. Since the bill expands that coverage to include a comprehensive list of services, drugs, screenings, and counseling, related to contraception and reproductive health, those sections of law specific to prescription female contraceptives are no longer required.
Finally, the bill provides that an individual shall not, on the basis of actual or perceived race, color, national origin, sex, sexual orientation, gender identity, age or disability, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination with respect to health insurance issued or delivered in this State with respect to the coverage of or payment for the services, drugs, devices, products and procedures described in the bill. A violation of this non-discrimination provision by any person shall be a violation of the New Jersey “Law Against Discrimination,” P.L.1945, c.169 (C.10:5-1 et seq.).