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AB-39 Health care coverage: contraceptive drugs.(1999-2000)

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Date Published:
AB39:v94#DOCUMENT

Assembly Bill No. 39
CHAPTER 532

An act to add Section 1367.25 to the Health and Safety Code, relating to health care coverage.

[ Filed with Secretary of State  September 28, 1999. Approved by Governor  September 27, 1999. ]

LEGISLATIVE COUNSEL'S DIGEST


AB 39, Hertzberg. Health care coverage: contraceptive drugs.
(1) Existing law provides for the licensure and regulation of health care service plans administered by the Commissioner of Corporations. Under existing law, a willful violation of any of these provisions is punishable as either a felony or a misdemeanor.
Existing law requires that health care service plans provide coverage for certain benefits and services.
This bill would require every group health care service plan contract, and every individual health care service plan contract, amended, renewed, or delivered on or after January 1, 2000, except for a specialized health care service plan contract, to provide coverage, under terms and conditions applicable to other benefits, for a variety of federal Food and Drug Administration approved prescription contraceptive methods. This bill would authorize certain religious employers, as defined, to request a health care service plan contract without coverage for those contraceptive methods in certain circumstances.
By changing the definition of the crime applicable to health care service plans, this bill would impose a state-mandated local program. (2) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

The people of the State of California do enact as follows:


SECTION 1.

 This act shall be known and may be cited as the Women’s Contraception Equity Act.

SEC. 2.

 Section 1367.25 is added to the Health and Safety Code, to read:

1367.25.
 (a) Every group health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, renewed, or delivered on or after January 1, 2000, and every individual health care service plan contract that is amended, renewed, or delivered on or after January 1, 2000, except for a specialized health care service plan contract, shall provide coverage for the following, under general terms and conditions applicable to all benefits:
(1) A health care service plan contract that provides coverage for outpatient prescription drug benefits shall include coverage for a variety of federal Food and Drug Administration approved prescription contraceptive methods designated by the plan. In the event the patient’s participating provider, acting within his or her scope of practice, determines that none of the methods designated by the plan is medically appropriate for the patient’s medical or personal history, the plan shall also provide coverage for another federal Food and Drug Administration approved, medically appropriate prescription contraceptive method prescribed by the patient’s provider.
(2) Outpatient prescription benefits for an enrollee shall be the same for an enrollee’s covered spouse and covered nonspouse dependents.
(b) Notwithstanding any other provision of this section, a religious employer may request a health care service plan contract without coverage for federal Food and Drug Administration approved contraceptive methods that are contrary to the religious employer’s religious tenets. If so requested, a health care service plan contract shall be provided without coverage for contraceptive methods. This subdivision shall not be construed to deny an enrollee coverage of, and timely access to, contraceptive methods.
(1) For purposes of this section, a “religious employer” is an entity for which each of the following is true:
(A) The inculcation of religious values is the purpose of the entity.
(B) The entity primarily employs persons who share the religious tenets of the entity.
(C) The entity serves primarily persons who share the religious tenets of the entity.
(D) 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.
(2) Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive health care services the employer refuses to cover for religious reasons.
(c) Nothing in this section shall be construed to exclude coverage for prescription contraceptive supplies ordered by a health care provider with prescriptive authority for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating symptoms of menopause, or for prescription contraception that is necessary to preserve the life or health of an enrollee.
(d) Nothing in this section shall be construed to deny or restrict in any way any existing right or benefit provided under law or by contract.
(e) Nothing in this section shall be construed to require an individual or group health care service plan to cover experimental or investigational treatments.

SEC. 3.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.