20-1057.08. Prescription contraceptive drugs and devices; definition

A. If a health care services organization issues evidence of coverage that provides coverage for:

1. Prescription drugs, the evidence of coverage shall provide coverage for any prescribed drug or device that is approved by the United States food and drug administration for use as a contraceptive. A health care services organization may use a drug formulary, multitiered drug formulary or list but that formulary or list shall include oral, implant and injectable contraceptive drugs, intrauterine devices and prescription barrier methods if the health care services organization does not impose deductibles, coinsurance, copayments or other cost containment measures for contraceptive drugs that are greater than the deductibles, coinsurance, copayments or other cost containment measures for other drugs on the same level of the formulary or list.

2. Outpatient health care services, the evidence of coverage shall provide coverage for outpatient contraceptive services. For the purposes of this paragraph, "outpatient contraceptive services" means consultations, examinations, procedures and medical services provided on an outpatient basis and related to the use of United States food and drug prescription contraceptive methods to prevent unintended pregnancies.

B. Notwithstanding subsection A, a religious employer whose religious tenets prohibit the use of prescribed contraceptive methods may require that the health care services organization provide coverage that excludes all federal food and drug administration approved contraceptive methods. A religious employer shall submit a written affidavit to the health care services organization stating that it is a religious employer. On receipt of the affidavit, the health care services organization shall provide coverage to the religious employer that excludes prescription contraceptive methods. The health care services organization shall retain the affidavit for the duration of the coverage and any renewals of the coverage.

C. Before enrollment in the health care plan, every religious employer that invokes this exemption shall provide prospective enrollees written notice that the religious employer refuses to cover all federal food and drug administration approved contraceptive methods for religious reasons.

D. Subsection B does not exclude coverage for prescription contraceptive methods ordered by a health care provider with prescriptive authority for medical indications other than to prevent an unintended pregnancy. A health care services organization may require the enrollee to first pay for the prescription and then submit a claim to the health care services organization along with evidence that the prescription is for a noncontraceptive purpose. A health care services organization may charge an administrative fee for handling claims under this subsection.

E. A religious employer shall not discriminate against an employee who independently chooses to obtain insurance coverage or prescriptions for contraceptives from another source.

F. This section does not apply to evidences of coverage issued to individuals on a nongroup basis.

G. For the purposes of this section, "religious employer" means an entity for which all of the following apply:

1. The entity primarily employs persons who share the religious tenets of the entity.

2. The entity serves primarily persons who share the religious tenets of the entity.

3. The entity is a nonprofit organization as described in section 6033(a)(2)(A)i or iii of the internal revenue code of 1986, as amended.

20-1057.08. Prescription contraceptive drugs and devices; definition

A. If a health care services organization issues evidence of coverage that provides coverage for:

1. Prescription drugs, the evidence of coverage shall provide coverage for any prescribed drug or device that is approved by the United States food and drug administration for use as a contraceptive. A health care services organization may use a drug formulary, multitiered drug formulary or list but that formulary or list shall include oral, implant and injectable contraceptive drugs, intrauterine devices and prescription barrier methods if the health care services organization does not impose deductibles, coinsurance, copayments or other cost containment measures for contraceptive drugs that are greater than the deductibles, coinsurance, copayments or other cost containment measures for other drugs on the same level of the formulary or list.

2. Outpatient health care services, the evidence of coverage shall provide coverage for outpatient contraceptive services. For the purposes of this paragraph, "outpatient contraceptive services" means consultations, examinations, procedures and medical services provided on an outpatient basis and related to the use of United States food and drug prescription contraceptive methods to prevent unintended pregnancies.

B. Notwithstanding subsection A, a religious employer whose religious tenets prohibit the use of prescribed contraceptive methods may require that the health care services organization provide coverage that excludes all federal food and drug administration approved contraceptive methods. A religious employer shall submit a written affidavit to the health care services organization stating that it is a religious employer. On receipt of the affidavit, the health care services organization shall provide coverage to the religious employer that excludes prescription contraceptive methods. The health care services organization shall retain the affidavit for the duration of the coverage and any renewals of the coverage.

C. Before enrollment in the health care plan, every religious employer that invokes this exemption shall provide prospective enrollees written notice that the religious employer refuses to cover all federal food and drug administration approved contraceptive methods for religious reasons.

D. Subsection B does not exclude coverage for prescription contraceptive methods ordered by a health care provider with prescriptive authority for medical indications other than to prevent an unintended pregnancy. A health care services organization may require the enrollee to first pay for the prescription and then submit a claim to the health care services organization along with evidence that the prescription is for a noncontraceptive purpose. A health care services organization may charge an administrative fee for handling claims under this subsection.

E. A religious employer shall not discriminate against an employee who independently chooses to obtain insurance coverage or prescriptions for contraceptives from another source.

F. This section does not apply to evidences of coverage issued to individuals on a nongroup basis.

G. For the purposes of this section, "religious employer" means an entity for which all of the following apply:

1. The entity primarily employs persons who share the religious tenets of the entity.

2. The entity serves primarily persons who share the religious tenets of the entity.

3. The entity is a nonprofit organization as described in section 6033(a)(2)(A)i or iii of the internal revenue code of 1986, as amended.