50 States Summary of Contraceptive Legislation

State Laws Requiring Insurance Coverage of Contraceptives

Updated June 2008

Nearly 62 million women in the U.S. are of reproductive age, meaning they are between the ages of 15 and 44. An estimated 11.6 million American women use oral contraceptives. According to the National Center for Chronic Disease Prevention and Health Promotion, nearly half of all pregnancies in the United States were unintended in 2001. Unintended pregnancies are associated with increased risk for poor outcomes. The United States has set a national goal of decreasing unintended pregnancies to thirty percent by the year 2010.

Employer-based coverage is the primary form of health insurance for 64 percent of women of reproductive age. Almost all insurance plans cover prescription drugs, but many still do not cover the range of contraceptive drugs and devices that are approved by the federal Food and Drug Administration (FDA). Federal law requires insurance coverage of contraceptives for federal employees and their dependents, allowing a few religious insurers exemption from the requirements.

At least 24 states have enacted legislation to mandate that insurers which cover prescription drugs also provide coverage for any Food and Drug Administration (FDA)-approved contraceptive. These states include: Arizona, Arkansas, California, 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 and West Virginia. An additional three states, Michigan, Montana, and Wisconsin, mandate insurance coverage of contraceptives as a result of administrative ruling or an Attorney General opinion. Two states, Texas and Virginia, mandate that employers be offered the option to include coverage of contraceptives within the health plan. Some laws prohibit insurance plans from excluding contraceptive services or supplies. Some states include an exemption for employers who object to such coverage for religious reasons. Several states also require employers to notify employees of their refusal to provide contraceptive coverage. Twenty-one states offer coverage exemptions (usually for religion) for insurers or employers in their policies: Arizona, Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Texas, and West Virginia. (These states are indicated with an * in the table below.)

For more information, please see the State Policies in Brief on Insurance Coverage of Contraceptives by the Guttmacher Institute, which features a state chart of coverage mandates.

First Letter of State A C D G H I M N O R T V W

State

Summary of Statutes

Arizona *

Ariz. Rev. Stat. Ann. § 20-2329 (2002) requires all health insurance plans providing coverage for prescription medications to also provide coverage for all FDA-approved prescription methods of contraception. (H.B. 2234)

Arkansas *

Ark. Stat. Ann. §23-79-1103 (2005) requires all health insurance plans providing coverage for prescription medications to also provide coverage for all FDA-approved prescription methods of contraception. This does not cover emergency contraception. (HB 2618)

California *

Cal. Insurance Code § 10123.196 and Cal. Health & Safety Code § 1367.25 (1999) require certain health insurance policies that already cover prescription drugs to provide coverage for prescription contraceptive methods approved by the FDA. (A.B. 39)

Connecticut *

Conn. Gen. Stat. § 38a-530e (1999) requires insurers that offer prescription drug coverage to include coverage for contraceptives. (Conn. Acts P.A. 99-79; HB 5950)

Delaware *

Del. Code Ann. tit. 18, § 3559 (2000) requires insurers that provide coverage for outpatient prescription drugs to provide coverage for prescription contraceptive drugs and devices. (Vol. 72 Del. Laws, Chap. 311; SB 87)

Georgia

Ga. Code § 33-24-59.1 and 33-24-59.6 (1999) require insurers that offer prescription drug coverage to include contraceptives.

Hawaii *

Hawaii Rev. Stat. § 432:1-604.5 and §431:10A-116.7 (1999) direct that employer group health policies, contracts, plans or agreements must cease to exclude contraceptive services or supplies, and must not charge "unusual" co-payments or impose waiting requirements. (Hawaii Laws, chap. 267 § 2)

Hawaii Rev. Stat. § 431:10A-116.6 (1999) defines a religious employer, and states that such an employer may request a health insurance plan without coverage for contraceptive services and supplies. The health insurer must provide a plan without such coverage. The law defines contraceptive services and contraceptive supplies. (Hawaii Laws, Chap. 267 § 2)

Illinois *

Ill. Rev. Stat. ch. 215 § 5/356z.4, § 125/5-3, §165/10 (2003) require coverage to include outpatient prescription contraceptive drugs, devices and outpatient contraceptive services without imposing limitations. (HB 211)

Iowa

Iowa Code § 514C.19 (2000) prohibits specified health insurance plans, including a public employer plan, that provides benefits for outpatient prescription drugs, devices, or services from excluding or restricting benefits for FDA-approved prescription contraceptives drugs, devices, or outpatient services. (Iowa Acts, Chap. 1120; SF 2126)

Maine *

Me. Rev. Stat. Ann. tit. 24 § 2332-J, Me. Rev. Stat. Ann. tit. 24a § 4247 (1999) require insurers that provide coverage for prescription drugs and outpatient medical services to provide coverage for all prescription contraceptives and outpatient contraceptive services.

Maryland *

Md. Health-General Code Ann. § 19-706 and Md. Insurance Code Ann. § 15-826 (1998) require private insurers to provide comprehensive coverage for contraceptives. Religious organizations may request exclusion from this policy.

Massachusetts *

Mass. Gen. Laws Ann. ch. 175 § 47W, ch. 176A § 8W, ch. 176B § 4W, and ch. 176G § 4O require insurers that provide benefits for outpatient services to also provide hormone replacement therapy for menopausal women and outpatient FDA-approved contraceptive services under the same terms and conditions as for other outpatient services. The law defines outpatient contraceptive services. (2002 Mass. Acts, Chap. No. 49; S.B. 2139)

Missouri *

Mo. Rev. Stat. § 376.1199 (2005) requires health carriers that provide pharmaceutical coverage to include coverage for contraceptives, excluding drugs and devices that are intended to induce an abortion. The bill clarifies that coverage for prescriptive contraceptive drugs or devices is not excluded if prescribed for other diagnosed medical conditions. The bill exempts specified insurance policies, including health carriers owned and operated by religious entities, from the provisions of the bill. The bill prohibits discrimination against an enrollee because of the enrollee's request regarding contraceptive coverage. The bill requires carriers to maintain the confidentiality of any individual's request for contraceptive coverage. (H.B. 762)

Nevada *

Nev. Rev. Stat. § 629.031, § 689A.0417, § 689B.0377, § 695B.1918, and § 695C.1695 (1999) require insurers that offer prescription drug coverage to include coverage for contraceptives.

New Hampshire
N.H. Rev. Stat. Ann. § 415:18-I, § 420-A:17-c and § 420-B:8-gg (1999) requires health insurers, health service corporations, and health maintenance organizations to provide coverage for outpatient contraceptive services. The law also states that health insurers that provide prescription riders must cover all prescription contraceptive drugs and prescription contraceptive devices approved by the FDA under the same terms and conditions as other prescription drugs.

New Jersey *
N.J. Stat. Ann. § 17:48-6ee, 48A-7bb, 48E-35.29, 48F-13.2, § 17B: 26-2.1y, 27-46.1ee, 27A-7.12, 27A-19.15; § 26: 2J-4.30; § 52: 14-17.29j (2005) require all health insurance or medical providers to cover prescription female contraceptive drugs and devices in the same way that other prescription drugs are covered. Religious employers and organizations may be granted an exception. They must provide written notice to their current and prospective subscribers about this exemption.

New Mexico *

N.M. Stat. Ann. § 59A-22-42 and § 59A-46-44 (2003) requires each individual and group health insurance policy, health care plan and certificate of health insurance that provides a prescription drug benefit to provide coverage for prescription contraceptive drugs or devices. (SB 557)

N.M. Stat. Ann. § 59A-22-42 (2001) requires most insurance plans to offer coverage for prescription contraceptive drugs or devices, which may be subject to deductibles and coinsurance. (N.M. Laws, Chap. 14; H 59)

New York *

N.Y. Insurance Law § 4303 (cc) (2002) requires insurers that provide coverage for prescription drugs shall include coverage for the cost of contraceptive drugs or devices approved by the FDA. Religious employers are allowed to deny employees contraceptive coverage provided that employees are informed in writing of such exclusions. Most insurers must provide written notice to enrollees of their right to directly purchase, for an additional premium at the small group community rate, a rider for coverage of contraceptives. (A.B. 11723)

North Carolina *

N.C. Gen. Stat. § 58-3-178 (1999) requires insurers that offer prescription drug coverage to include coverage for contraceptives and outpatient contraceptive services.

Ohio

Ohio Rev. Code Ann. § 1751.01 (A)(7) requires health insurance corporations to provide basic health services, including medically necessary voluntary family planning services.

Oregon *

2007 Or. Law, Chap. 182 specifies that a prescription drug benefit program, or a prescription drug benefit offered under a health benefit plan or under a student health insurance policy, must provide payment, coverage or reimbursement for prescription contraceptives and outpatient consultations, examinations, procedures and medical services that are necessary to prescribe, dispense, deliver, distribute, administer or remove a prescription contraceptive (HB 2700).

Rhode Island *

R.I. Gen. Laws § 27-18-57; § 27-19-48; § 27-20-43; § 27-41-59 (2000) requires specified health insurance plans that provide prescription coverage to also provide coverage for FDA-approved prescription contraceptive drugs and devices. (R.I. Pub. Laws, Chap. 120; SB 2367)

Texas *

Tex. Insurance Code Ann. § 1369.104 et seq. (2001) prohibits a health benefit plan that provides benefits for prescription drugs or devices from excluding prescription contraceptives approved by the FDA. The law does not apply to coverage for abortifacients or any other drug or device that terminates a pregnancy. The law prohibits a health benefit plan from imposing cost-sharing provisions on prescription contraceptives. The law states that a health benefit plan may not impose any waiting period for prescription contraceptives. The law does not require a health benefit plan associated with a religious organization to offer a medical or health care service that violates the religious convictions of the organization, except if the prescription contraceptive coverage is necessary to preserve the life or health of the insured individual. (HB 2382)

Vermont

Vt. Stat. Ann. tit. 8 § 4099c (1999) requires health insurance plans to provide coverage for contraceptives if they cover prescription drugs.

Virginia

Va. Code § 2.1-201.1, § 32.1-325 and § 38.2-3407.4:2 (2001) require that the health and related insurance for state employees include coverage for prescription drugs and devices used as contraceptives. (Va. Laws, Chap. 334; H 2654)

Va. Code § 38.2-3407.5:1 (1997) requires insurers that provide coverage for prescription drugs to offer and make available coverage for FDA-approved contraceptive drugs or devices, at the option of the purchaser. This law is not a mandate for coverage.

Washington

Wash. Rev. Code § 48.41.110 requires health insurance policies issued by the state health insurance pool to provide coverage for drugs and contraceptive devices requiring a prescription.

West Virginia *

W. Va. Code § 33-25A-2(1), (11) (1996, 1997) requires HMOs to provide or make available basic health care services that encompass coverage for voluntary family planning services.

W. Va. Code § 33-16E-1, 16E-2, 16E-3, 16E-4, 16E-5, 16E-6, and 16E-7 (2005) requires prescription drug parity; all health plans and medical service organizations must cover FDA approved prescription drugs and devices under the same guidelines they cover other prescription drugs. Extraordinary surcharges are prohibited. Religious employers may be exempt, but must provide potential or current subscribers written notice of the policy and make arrangements for them to purchase drugs or devices at the prevailing group rate from another providor. The law does not apply to Medicaid.

Source: National Conference of State Legislatures and the Guttmacher Institute, 2008
Note: List may not be comprehensive, but is representative of state laws that exist. NCSL appreciates additions and corrections.

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