Bill Text: NJ S1492 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires health insurance coverage and limits cost sharing for certain birth control methods.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-01-09 - Introduced in the Senate, Referred to Senate Commerce Committee [S1492 Detail]
Download: New_Jersey-2024-S1492-Introduced.html
STATE OF NEW JERSEY
221st LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2024 SESSION
Sponsored by:
Senator SHIRLEY K. TURNER
District 15 (Hunterdon and Mercer)
SYNOPSIS
Requires health insurance coverage and limits cost sharing for certain birth control methods.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning insurance coverage for birth control methods and amending P.L.2005, c.251.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.2005, c.251 (C.17:48-6ee) is amended to read as follows:
1. A hospital service corporation that provides hospital or medical expense 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, regardless of whether coverage for outpatient prescription drugs are provided, for male sterilization procedures. For the purposes of this section, "prescription female contraceptives" means any drug or device used for contraception by a female, which is approved by the federal Food and Drug Administration for that purpose, that can only be purchased in this State with a prescription written by a health care professional licensed or authorized to write prescriptions, and includes, but is not limited to, birth control pills and diaphragms. The coverage provided shall include prescriptions for dispensing contraceptives for:
a. a three-month period for the first dispensing of the contraceptive; and
b. a six-month period for any subsequent dispensing of the same contraceptive, regardless of whether coverage under the contract was in effect at the time of the first dispensing, except that an entity subject to this section may provide coverage for a supply of contraceptives that is for less than a six-month period, if a six-month period would extend beyond the term of the contract.
A religious employer may request, and a hospital service corporation 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 subscribers and subscribers. The provisions of this section shall not be construed as authorizing a hospital service corporation 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 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).
The benefits shall be provided to the same extent as for any other outpatient prescription drug under the contract, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imposed. In the case of a high-deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. 223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for the benefits shall be provided without cost-sharing as provided in this section.
This section shall apply to those contracts in which the hospital service corporation has reserved the right to change the premium.
(cf: P.L.2017, c.241, s.1)
2. Section 2 of P.L.2005, c.251 (C.17:48A-7bb) is amended to read as follows:
2. A medical service corporation that provides hospital or medical expense 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, regardless of whether coverage for outpatient prescription drugs are provided, for male sterilization procedures. For the purposes of this section, "prescription female contraceptives" means any drug or device used for contraception by a female, which is approved by the federal Food and Drug Administration for that purpose, that can only be purchased in this State with a prescription written by a health care professional licensed or authorized to write prescriptions, and includes, but is not limited to, birth control pills and diaphragms. The coverage provided shall include prescriptions for dispensing contraceptives for:
a. a three-month period for the first dispensing of the contraceptive; and
b. a six-month period for any subsequent dispensing of the same contraceptive, regardless of whether coverage under the contract was in effect at the time of the first dispensing, except that an entity subject to this section may provide coverage for a supply of contraceptives that is for less than a six-month period, if a six-month period would extend beyond the term of the contract.
A religious employer may request, and a medical service corporation 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 subscribers and subscribers. The provisions of this section shall not be construed as authorizing a medical service corporation 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 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).
The benefits shall be provided to the same extent as for any other outpatient prescription drug under the contract, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imposed. In the case of a high-deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. 223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for the benefits shall be provided without cost-sharing as provided in this section.
This section shall apply to those contracts in which the medical service corporation has reserved the right to change the premium.
(cf: P.L.2017, c.241, s.2)
3. Section 3 of P.L.2005, c.251 (C.17:48E-35.29) is amended to read as follows:
3. A health service corporation that provides hospital or medical expense 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, regardless of whether coverage for outpatient prescription drugs are provided, for male sterilization procedures. For the purposes of this section, "prescription female contraceptives" means any drug or device used for contraception by a female, which is approved by the federal Food and Drug Administration for that purpose, that can only be purchased in this State with a prescription written by a health care professional licensed or authorized to write prescriptions, and includes, but is not limited to, birth control pills and diaphragms. The coverage provided shall include prescriptions for dispensing contraceptives for:
a. a three-month period for the first dispensing of the contraceptive; and
b. a six-month period for any subsequent dispensing of the same contraceptive, regardless of whether coverage under the contract was in effect at the time of the first dispensing, except that an entity subject to this section may provide coverage for a supply of contraceptives that is for less than a six-month period, if a six-month period would extend beyond the term of the contract.
A religious employer may request, and a health service corporation 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 subscribers and subscribers. The provisions of this section shall not be construed as authorizing a health service corporation 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 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).
The benefits shall be provided to the same extent as for any other outpatient prescription drug under the contract, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imposed. In the case of a high-deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. 223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for the benefits shall be provided without cost-sharing as provided in this section.
This section shall apply to those contracts in which the health service corporation has reserved the right to change the premium.
(cf: P.L.2017, c.241, s.3)
4. Section 4 of P.L. 2005, c.251 (C.17B:27-46.1ee) is amended to read as follows:
4. A group health insurer that provides hospital or medical expense benefits for expenses incurred in the purchase of outpatient prescription drugs under a policy 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, regardless of whether coverage for outpatient prescription drugs are provided, for male sterilization procedures. For the purposes of this section, "prescription female contraceptives" means any drug or device used for contraception by a female, which is approved by the federal Food and Drug Administration for that purpose, that can only be purchased in this State with a prescription written by a health care professional licensed or authorized to write prescriptions, and includes, but is not limited to, birth control pills and diaphragms. The coverage provided shall include prescriptions for dispensing contraceptives for:
a. a three-month period for the first dispensing of the contraceptive; and
b. a six-month period for any subsequent dispensing of the same contraceptive, regardless of whether coverage under the policy was in effect at the time of the first dispensing, except that an entity subject to this section may provide coverage for a supply of contraceptives that is for less than a six-month period, if a six-month period would extend beyond the term of the contract.
A religious employer may request, and an insurer shall grant, an exclusion under the policy 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 insureds and insureds. The provisions of this section 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. 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).
The benefits shall be provided to the same extent as for any other outpatient prescription drug under the policy, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imposed. In the case of a high-deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. 223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for the benefits shall be provided without cost-sharing as provided in this section.
This section shall apply to those policies in which the insurer has reserved the right to change the premium.
(cf: P.L.2017, c.241, s.4)
5. Section 5 of P.L.2005, c.251 (C.17B:26-2.1y) is amended to read as follows:
5. An individual health insurer that provides hospital or medical expense benefits for expenses incurred in the purchase of outpatient prescription drugs under a policy 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, regardless of whether coverage for outpatient prescription drugs are provided, for male sterilization procedures. For the purposes of this section, "prescription female contraceptives" means any drug or device used for contraception by a female, which is approved by the federal Food and Drug Administration for that purpose, that can only be purchased in this State with a prescription written by a health care professional licensed or authorized to write prescriptions, and includes, but is not limited to, birth control pills and diaphragms. The coverage provided shall include prescriptions for dispensing contraceptives for:
a. a three-month period for the first dispensing of the contraceptive; and
b. a six-month period for any subsequent dispensing of the same contraceptive, regardless of whether coverage under the policy was in effect at the time of the first dispensing, except that an entity subject to this section may provide coverage for a supply of contraceptives that is for less than a six-month period, if a six-month period would extend beyond the term of the contract.
A religious employer may request, and an insurer shall grant, an exclusion under the policy 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 insureds and insureds. The provisions of this section 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. 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).
The benefits shall be provided to the same extent as for any other outpatient prescription drug under the policy, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imposed. In the case of a high-deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. 223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for the benefits shall be provided without cost-sharing as provided in this section.
This section shall apply to those policies in which the insurer has reserved the right to change the premium.
(cf: P.L.2017, c.241, s.5)
6. Section 6 of P.L.2005, c.251 (C.26:2J-4.30) is amended to read as follows:
6. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued on or after the effective date of this act for a health maintenance organization that provides health care services for outpatient prescription drugs under a contract, unless the health maintenance organization also provides health care services for prescription female contraceptives and, regardless of whether coverage for outpatient prescription drugs are provided, for male sterilization procedures. For the purposes of this section, "prescription female contraceptives" means any drug or device used for contraception by a female, which is approved by the federal Food and Drug Administration for that purpose, that can only be purchased in this State with a prescription written by a health care professional licensed or authorized to write prescriptions, and includes, but is not limited to, birth control pills and diaphragms. The coverage provided shall include prescriptions for dispensing contraceptives for:
a. a three-month period for the first dispensing of the contraceptive; and
b. a six-month period for any subsequent dispensing of the same contraceptive, regardless of whether coverage under the contract was in effect at the time of the first dispensing, except that an entity subject to this section may provide coverage for a supply of contraceptives that is for less than a six-month period, if a six-month period would extend beyond the term of the contract.
A religious employer may request, and a health maintenance organization shall grant, an exclusion under the contract for the health care services required by this section if the required health care services conflict 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 health maintenance organization to exclude health care services 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).
The health care services shall be provided to the same extent as for any other outpatient prescription drug under the contract, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imposed. In the case of a high-deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. 223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for the benefits shall be provided without cost-sharing as provided in this section.
The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.
(cf: P.L.2017, c.241, s.6.)
7. Section 7 of P.L.2005, c.251 (C.17B:27A-7.12) is amended to read as follows:
7. An individual health benefits plan required pursuant to section 3 of P.L.1992, c.161 (C.17B:27A-4) that provides benefits for expenses incurred in the purchase of outpatient prescription drugs shall provide coverage for expenses incurred in the purchase of prescription female contraceptives and, regardless of whether coverage for outpatient prescription drugs are provided, for male sterilization procedures. For the purposes of this section, "prescription female contraceptives" means any drug or device used for contraception by a female, which is approved by the federal Food and Drug Administration for that purpose, that can only be purchased in this State with a prescription written by a health care professional licensed or authorized to write prescriptions, and includes, but is not limited to, birth control pills and diaphragms. The coverage provided shall include prescriptions for dispensing contraceptives for:
a. a three-month period for the first dispensing of the contraceptive; and
b. a six-month period for any subsequent dispensing of the same contraceptive, regardless of whether coverage under the plan was in effect at the time of the first dispensing, except that an entity subject to this section may provide coverage for a supply of contraceptives that is for less than a six-month period, if a six-month period would extend beyond the term of the contract.
A religious employer may request, and a carrier shall grant, an exclusion under the health benefits plan 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 covered persons and covered persons. The provisions of this section shall not be construed as authorizing a carrier 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 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).
The benefits shall be provided to the same extent as for any other outpatient prescription drug under the health benefits plan, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imposed. In the case of a high-deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. 223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for the benefits shall be provided without cost-sharing as provided in this section.
This section shall apply to all individual health benefits plans in which the carrier has reserved the right to change the premium.
(cf: P.L.2017, c.241, s.7)
8. Section 8 of P.L.2005, c.251 (C.17B:27A-19.15) is amended to read as follows:
8. A small employer health benefits plan required pursuant to section 3 of P.L.1992, c.162 (C.17B:27A-19) that provides benefits for expenses incurred in the purchase of outpatient prescription drugs shall provide coverage for expenses incurred in the purchase of prescription female contraceptives and, regardless of whether coverage for outpatient prescription drugs are provided, for male sterilization procedures. For the purposes of this section, "prescription female contraceptives" means any drug or device used for contraception by a female, which is approved by the federal Food and Drug Administration for that purpose, that can only be purchased in this State with a prescription written by a health care professional licensed or authorized to write prescriptions, and includes, but is not limited to, birth control pills and diaphragms. The coverage provided shall include prescriptions for dispensing contraceptives for:
a. a three-month period for the first dispensing of the contraceptive; and
b. a six-month period for any subsequent dispensing of the same contraceptive, regardless of whether coverage under the plan was in effect at the time of the first dispensing, except that an entity subject to this section may provide coverage for a supply of contraceptives that is for less than a six-month period, if a six-month period would extend beyond the term of the contract.
A religious employer may request, and a carrier shall grant, an exclusion under the health benefits plan 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 covered persons and covered persons. The provisions of this section shall not be construed as authorizing a carrier 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 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).
The benefits shall be provided to the same extent as for any other outpatient prescription drug under the health benefits plan, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imposed. In the case of a high-deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. 223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for the benefits shall be provided without cost-sharing as provided in this section.
This section shall apply to all small employer health benefits plans in which the carrier has reserved the right to change the premium.
(cf: P.L.2017, c.241, s.8)
9. Section 9 of P.L.2005, c.251 (C.17:48F-13.2) is amended to read as follows:
9. 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, regardless of whether coverage for outpatient prescription drugs are provided, for male sterilization procedures. For the purposes of this section, "prescription female contraceptives" means any drug or device used for contraception by a female, which is approved by the federal Food and Drug Administration for that purpose, that can only be purchased in this State with a prescription written by a health care professional licensed or authorized to write prescriptions, and includes, but is not limited to, birth control pills and diaphragms. The coverage provided shall include prescriptions for dispensing contraceptives for:
a. a three-month period for the first dispensing of the contraceptive; and
b. a six-month period for any subsequent dispensing of the same contraceptive, regardless of whether coverage under the contract was in effect at the time of the first dispensing, except that an entity subject to this section may provide coverage for a supply of contraceptives that is for less than a six-month period, if a six-month period would extend beyond the term of the contract.
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).
The benefits shall be provided to the same extent as for any other outpatient prescription drug under the contract, except no deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage shall be imposed. In the case of a high-deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. 223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for the benefits shall be provided without cost-sharing as provided in this section.
This section shall apply to those prepaid prescription contracts in which the prepaid prescription service organization has reserved the right to change the premium.
(cf: P.L.2017, c.241, s.9)
10. Section 10 of P.L.2005, c.251 (C.52:14-17.29j) is amended to read as follows:
10. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides benefits for expenses incurred in the purchase of outpatient prescription drugs shall provide benefits for expenses incurred in the purchase of prescription female contraceptives and, regardless of whether coverage for outpatient prescription drugs are provided, for male sterilization procedures.
For the purposes of this section, "prescription female contraceptives" means any drug or device used for contraception by a female, which is approved by the federal Food and Drug Administration for that purpose, that can only be purchased in this State with a prescription written by a health care professional licensed or authorized to write prescriptions, and includes, but is not limited to, birth control pills and diaphragms. The coverage provided shall include prescriptions for dispensing contraceptives for:
a. a three-month period for the first dispensing of the contraceptive; and
b. a six-month period for any subsequent dispensing of the same contraceptive, regardless of whether coverage under the contract was in effect at the time of the first dispensing, except that an entity subject to this section may provide coverage for a supply of contraceptives that is for less than a six-month period, if a six-month period would extend beyond the term of the contract.
The contract shall specify that no deductible, coinsurance, copayment, or any other cost-sharing requirement may be imposed on the coverage required pursuant to this section. In the case of a high-deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under the plan have met the amount of the minimum annual deductibles in effect under section 223(c)(2)(A)(i) of the federal Internal Revenue Code (26 U.S.C. 223(c)(2)(A)(i)) for self-only and family coverage, respectively. Once the foregoing expenditure amount has been met under the plan, coverage for the benefits shall be provided without cost-sharing as provided in this section.
(cf: P.L.2017, c.241, s.10)
11. This act shall take effect on the 90th day next following enactment and shall apply to policies or contracts issued or renewed on or after the effective date.
STATEMENT
This bill amends P.L.2005, c.251, the statute requiring health insurance carriers and the State health benefits programs to cover prescription female contraceptives, by also requiring coverage for male sterilization procedures and by prohibiting insurers from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on these coverages.
Currently, federal law requires coverage for female contraceptives to be provided without cost sharing in certain circumstances. This bill would expand State law to also require coverage for female contraceptives and male sterilization procedures to be provided without cost sharing.
The bill also specifies that, in the case of a high deductible health plan, the limitation on cost-sharing shall not be applied until the expenditures applicable to the deductible under federal law have been met. Once the foregoing expenditure amount has been met under the plan, coverage for prescription female contraceptives and male sterilization procedures benefits is to be provided without cost-sharing.
