House bill mandating infertility insurance be offered
The cost-sharing limits imposed under this subsection shall not apply to a high deductible plan as that term is used in subsection (f) of section 38a-493.(c) Any insurance company, hospital service corporation, medical service corporation, health care center or other entity providing coverage of the type specified in subsection (a) of this section may use step therapy, as defined in section 38a-510, within a contraceptive method or require prior authorization within a contraceptive method for the methods and services required under subsection (a) of this section.The ACA requires health insurance policies, except grandfathered ones, to cover these women's health services, immunizations, and preventive services with no cost sharing.
To the extent an existing state insurance law requires coverage of a health service or benefit that conflicts with the scope of an essential health benefit, the bill requires a policy to cover the service or benefit that provides greater coverage to the insured person, as determined by the insurance commissioner.
Notwithstanding any other provision of this section, any insurance company, hospital service corporation, medical service corporation or health care center that is owned, operated or substantially controlled by a religious organization that has religious or moral tenets that conflict with the requirements of this section may provide for the coverage of prescription contraceptive methods as required under this section through another such entity offering a limited benefit plan.
The cost, terms and availability of such coverage shall not differ from the cost, terms and availability of other prescription coverage offered to the insured.(a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [that provides coverage for outpatient prescription drugs approved by the federal Food and Drug Administration shall not exclude coverage for prescription contraceptive methods approved by the federal Food and Drug Administration.(2) If a contraceptive method described in subdivision (1) of this subsection is prescribed by a licensed physician, physician assistant or advanced practice registered nurse, a twelve-month supply of such contraceptive method dispensed at one time or at multiple times, provided an insured shall not be entitled to receive a twelve-month supply of such contraceptive method more than once during any plan year;(4) Counseling in (A) contraceptive methods approved by the federal Food and Drug Administration, and (B) the proper use of contraceptive methods approved by the federal Food and Drug Administration; and(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the methods and services required under subsection (a) of this section, except that any such policy that uses a provider network may require cost-sharing when such methods and services are rendered by an out-of-network provider.
Act 34 provides that the documentation submitted to the Council by supporters and opponents of a proposed mandated benefit should address eight specific areas.
In reviewing these eight points, Council staff performs a preliminary review to determine whether the information received is sufficient to warrant the formal Mandated Benefits Review process outlined in the Act.
It generally requires policies to cover these services in full with no cost sharing (such as coinsurance, copayments, or deductibles), except for high deductible plans designed to be compatible with federally qualified health savings accounts.