Shown verbatim: the complete text as captured from the official PDF posted by the Rhode Island General Assembly, fetched 2026-07-29. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
H7323 2026 -- H 7323 ======== LC004206 ======== STATE OF RHODE ISLAND IN GENERAL ASSEMBLY JANUARY SESSION, A.D. 2026 ____________ A N A C T RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES Introduced By: Representatives Alzate, Fogarty, Donovan, Spears, Carson, J. Lombardi, Diaz, Cotter, Cruz, and Kislak Date Introduced: January 23, 2026 Referred To: House Finance It is enacted by the General Assembly as follows: 1 SECTION 1. Section 27-18-57 of the General Laws in Chapter 27-18 entitled Accident 2 and Sickness Insurance Policies is hereby amended to read as follows: 3 27-18-57. FDA approved prescription contraceptive drugs and devices. 4 (a) Every individual or group health insurance contract, plan, or policy issued pursuant to 5 this title that provides prescription coverage and is delivered, issued for delivery, or renewed , 6 amended or effective in this state on or after January 1, 2027 shall provide coverage for FDA 7 approved contraceptive drugs and devices requiring a prescription all of the following services and 8 contraceptive methods . Provided, that nothing in this subsection shall be deemed to mandate or 9 require coverage for the prescription drug RU 486. 10 (1) All FDA-approved contraceptive drugs, devices, and other products. The following 11 applies to this coverage: 12 (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 13 product, the contract shall include either the original FDA-approved contraceptive drug, device, or 14 product or at least one of its therapeutic equivalents. Therapeutic equivalent shall have the same 15 definition as that set forth by the FDA; 16 (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 17 available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 18 blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 19 contraceptive drug, device, or product, based on the determination of the health care provider, 1 without cost-sharing; and 2 (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- 3 counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 4 over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 5 management restrictions; 6 (2) Voluntary sterilization procedures; 7 (3) Clinical services related to the provision or use of contraception, including 8 consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 9 education, referrals, and counseling; and 10 (4) Follow-up services related to the drugs, devices, products, and procedures covered 11 under this section, including, but not limited to, management of side effects, counseling for 12 continued adherence, and device insertion and removal. 13 (b) A group or blanket policy subject to this section shall not impose a deductible, 14 coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 15 to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 16 shall establish the plan s cost-sharing for the coverage provided pursuant to this section at the 17 minimum level necessary to preserve the enrollee s ability to claim tax-exempt contributions and 18 withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 19 impose utilization control or other forms of medical management limiting the supply of FDA- 20 approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 21 location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 22 than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 23 such coverage other than a pharmacy claim. 24 (c) Except as otherwise authorized under this section, a group or blanket policy shall not 25 impose any restrictions or delays on the coverage required under this section. 26 (d) Benefits for an enrollee under this section shall be the same for an enrollee s covered 27 spouse or domestic partner and covered non-spouse dependents. 28 (b) (e) Notwithstanding any other provision of this section, any insurance company may 29 issue to a religious employer an individual or group health insurance contract, plan, or policy that 30 excludes coverage for prescription contraceptive methods that are contrary to the religious 31 employer’s bona fide religious tenets. The exclusion from coverage under this subsection shall not 32 apply to contraceptive services or procedures provided for purposes other than contraception, such 33 as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. 34 (c) (f) As used in this section, “religious employer” means an employer that is a “church or LC004206 - Page 2 of 15 1 a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 2 (d) (g) This section does not apply to insurance coverage providing benefits for: (1) Hospital 3 confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare 4 supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily 5 injury or death by accident or both; and (9) Other limited benefit policies. 6 (e) (h) Every religious employer that invokes the exemption provided under this section 7 shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 8 contraceptive healthcare services the employer refuses to cover for religious reasons. 9 (f) (i) Beginning on the first day of each plan year after April 1, 2019, every health insurance 10 issuer offering group or individual health insurance coverage that covers prescription contraception 11 shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three 12 hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the 13 course of the twelve (12) month period at the discretion of the prescriber . 14 (j) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 15 devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 16 ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 17 preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 18 accordance with § 27-18-20. The office of the health insurance commissioner ( commissioner ) 19 may base its determinations on findings from onsite surveys, enrollee or other complaints, financial 20 status, or any other source. 21 (k) The commissioner shall monitor plan compliance in accordance with this section and 22 shall adopt rules and regulations for the implementation of this section, including the following: 23 (1) In addition to any requirements under state administrative procedures, the 24 commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations 25 that include health care service plans, pharmacy benefit plans, consumer representatives, including 26 those representing youth, low-income people, and communities of color, and other interested 27 parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to 28 ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage. 29 The commissioner shall provide notice of stakeholder meetings on the department s website, and 30 stakeholder meetings shall be open to the public. 31 (2) The commissioner shall conduct random reviews of each plan and its subcontractors to 32 ensure compliance with this section. 33 (3) The commissioner shall submit an annual report to the general assembly and any other 34 appropriate entity with its findings from the random compliance reviews detailed in this section LC004206 - Page 3 of 15 1 and any other compliance or implementation efforts. This report shall be made available to the 2 public on the commissioner s website. 3 SECTION 2. Section 27-19-48 of the General Laws in Chapter 27-19 entitled Nonprofit 4 Hospital Service Corporations is hereby amended to read as follows: 5 27-19-48. FDA approved prescription contraceptive drugs and devices. 6 (a) Every individual or group health insurance contract, plan, or policy issued pursuant to 7 this title that provides prescription coverage and is delivered, issued for delivery, or renewed , 8 amended or effective in this state on or after January 1, 2027 shall provide coverage for FDA 9 approved contraceptive drugs and devices requiring a prescription all of the following services and 10 contraceptive methods . Provided, that nothing in this subsection shall be deemed to mandate or 11 require coverage for the prescription drug RU 486. 12 (1) All FDA-approved contraceptive drugs, devices, and other products. The following 13 applies to this coverage: 14 (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 15 product, the contract shall include either the original FDA-approved contraceptive drug, device, or 16 product or at least one of its therapeutic equivalents. Therapeutic equivalent shall have the same 17 definition as that set forth by the FDA; 18 (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 19 available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 20 blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 21 contraceptive drug, device, or product, based on the determination of the health care provider, 22 without cost-sharing; and 23 (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- 24 counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 25 over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 26 management restrictions; 27 (2) Voluntary sterilization procedures; 28 (3) Clinical services related to the provision or use of contraception, including 29 consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 30 education, referrals, and counseling; and 31 (4) Follow-up services related to the drugs, devices, products, and procedures covered 32 under this section, including, but not limited to, management of side effects, counseling for 33 continued adherence, and device insertion and removal. 34 (b) A group or blanket policy subject to this section shall not impose a deductible, LC004206 - Page 4 of 15 1 coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 2 to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 3 shall establish the plan s cost-sharing for the coverage provided pursuant to this section at the 4 minimum level necessary to preserve the enrollee s ability to claim tax-exempt contributions and 5 withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 6 impose utilization control or other forms of medical management limiting the supply of FDA- 7 approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 8 location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 9 than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 10 such coverage other than a pharmacy claim. 11 (c) Except as otherwise authorized under this section, a group or blanket policy shall not 12 impose any restrictions or delays on the coverage required under this section. 13 (d) Benefits for an enrollee under this section shall be the same for an enrollee s covered 14 spouse or domestic partner and covered non-spouse dependents. 15 (b) (e) Notwithstanding any other provision of this section, any hospital service corporation 16 may issue to a religious employer an individual or group health insurance contract, plan, or policy 17 that excludes coverage for prescription contraceptive methods that are contrary to the religious 18 employer’s bona fide religious tenets. The exclusion from coverage under this subsection shall not 19 apply to contraceptive services or procedures provided for purpose other than contraception, such 20 as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. 21 (c) (f) As used in this section, “religious employer” means an employer that is a “church or 22 a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 23 (d) (g) Every religious employer that invokes the exemption provided under this section 24 shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 25 contraceptive healthcare services the employer refuses to cover for religious reasons. 26 (e) (h) Beginning on the first day of each plan year after April 1, 2019, every health 27 insurance issuer offering group or individual health insurance coverage that covers prescription 28 contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive 29 up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once 30 or over the course of the twelve (12) month period at the discretion of the prescriber . 31 (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 32 devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 33 ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 34 preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in LC004206 - Page 5 of 15 1 accordance with § 27-19-38. The commissioner may base its determinations on findings from 2 onsite surveys, enrollee or other complaints, financial status, or any other source. 3 (j) The commissioner shall monitor plan compliance in accordance with this section and 4 shall adopt rules and regulations for the implementation of this section, including the following: 5 (1) In addition to any requirements under state administrative procedures, the 6 commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations 7 that include health care service plans, pharmacy benefit plans, consumer representatives, including 8 those representing youth, low-income people, and communities of color, and other interested 9 parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to 10 ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage. 11 The commissioner shall provide notice of stakeholder meetings on the commissioner s website, and 12 stakeholder meetings shall be open to the public. 13 (2) The commissioner shall conduct random reviews of each plan and its subcontractors to 14 ensure compliance with this section. 15 (3) The commissioner shall submit an annual report to the general assembly and any other 16 appropriate entity with its findings from the random compliance reviews detailed in this section 17 and any other compliance or implementation efforts. This report shall be made available to the 18 public on the commissioner s website. 19 SECTION 3. Section 27-20-43 of the General Laws in Chapter 27-20 entitled Nonprofit 20 Medical Service Corporations is hereby amended to read as follows: 21 27-20-43. FDA approved prescription contraceptive drugs and devices. 22 (a) Every individual or group health insurance contract, plan, or policy issued pursuant to 23 this title that provides prescription coverage and is delivered, issued for delivery, or renewed , 24 amended or effective in this state on or after January 1, 2027 shall provide coverage for FDA 25 approved contraceptive drugs and devices requiring a prescription all of the following services and 26 contraceptive methods . Provided, that nothing in this subsection shall be deemed to mandate or 27 require coverage for the prescription drug RU 486. 28 (1) All FDA-approved contraceptive drugs, devices and other products. The following 29 applies to this coverage: 30 (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 31 product, the contract shall include either the original FDA-approved contraceptive drug, device, or 32 product or at least one of its therapeutic equivalents. Therapeutic equivalent shall have the same 33 definition as that set forth by the FDA; 34 (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not LC004206 - Page 6 of 15 1 available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 2 blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 3 contraceptive drug, device, or product, based on the determination of the health care provider, 4 without cost-sharing; and 5 (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- 6 counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 7 over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 8 management restrictions; 9 (2) Voluntary sterilization procedures; 10 (3) Clinical services related to the provision or use of contraception, including 11 consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 12 education, referrals, and counseling; and 13 (4) Follow-up services related to the drugs, devices, products, and procedures covered 14 under this section, including, but not limited to, management of side effects, counseling for 15 continued adherence, and device insertion and removal. 16 (b) A group or blanket policy subject to this section shall not impose a deductible, 17 coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 18 to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 19 shall establish the plan s cost-sharing for the coverage provided pursuant to this section at the 20 minimum level necessary to preserve the enrollee s ability to claim tax-exempt contributions and 21 withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 22 impose utilization control or other forms of medical management limiting the supply of FDA- 23 approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 24 location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 25 than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 26 such coverage other than a pharmacy claim. 27 (c) Except as otherwise authorized under this section, a group or blanket policy shall not 28 impose any restrictions or delays on the coverage required under this section. 29 (d) Benefits for an enrollee under this section shall be the same for an enrollee s covered 30 spouse or domestic partner and covered non-spouse dependents. 31 (b) (e) Notwithstanding any other provision of this section, any medical service corporation 32 may issue to a religious employer an individual or group health insurance contract, plan, or policy 33 that excludes coverage for prescription contraceptive methods that are contrary to the religious 34 employer’s bona fide religious tenets. The exclusion from coverage under this subsection, shall not LC004206 - Page 7 of 15 1 apply to contraceptive services or procedures provided for purposes other than contraception, such 2 as decreasing the risk of ovarian cancer or eliminating symptoms of menopause. 3 (c) (f) As used in this section, “religious employer” means an employer that is a “church or 4 a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 5 (d) (g) Every religious employer that invokes the exemption provided under this section 6 shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 7 contraceptive healthcare services the employer refuses to cover for religious reasons. 8 (e) (h) Beginning on the first day of each plan year after April 1, 2019, every health 9 insurance issuer offering group or individual health insurance coverage that covers prescription 10 contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive 11 up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once 12 or over the course of the twelve (12) month period at the discretion of the prescriber . 13 (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 14 devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 15 ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 16 preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 17 accordance with § 27-20-33. The commissioner may base its determinations on findings from 18 onsite surveys, enrollee or other complaints, financial status, or any other source. 19 (j) The commissioner shall monitor plan compliance in accordance with this section and 20 shall adopt rules and regulations for the implementation of this section, including the following: 21 (1) In addition to any requirements under state administrative procedures, the 22 commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations 23 that include health care service plans, pharmacy benefit plans, consumer representatives, including 24 those representing youth, low-income people, and communities of color, and other interested 25 parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to 26 ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage. 27 The commissioner shall provide notice of stakeholder meetings on the commissioner s website, and 28 stakeholder meetings shall be open to the public. 29 (2) The commissioner shall conduct random reviews of each plan and its subcontractors to 30 ensure compliance with this section. 31 (3) The commissioner shall submit an annual report to the general assembly and any other 32 appropriate entity with its findings from the random compliance reviews detailed in this section 33 and any other compliance or implementation efforts. This report shall be made available to the 34 public on the commissioner s website. LC004206 - Page 8 of 15 1 SECTION 4. Section 27-41-59 of the General Laws in Chapter 27-41 entitled Health 2 Maintenance Organizations is hereby amended to read as follows: 3 27-41-59. FDA approved prescription contraceptive drugs and devices. 4 (a) Every individual or group health insurance contract, plan, or policy issued pursuant to 5 this title that provides prescription coverage and is delivered, issued for delivery, or renewed , 6 amended or effective in this state on or after January 1, 2027 shall provide coverage for FDA 7 approved contraceptive drugs and devices requiring a prescription; provided, all of the following 8 services and contraceptive methods. Provided, that nothing in this subsection shall be deemed to 9 mandate or require coverage for the prescription drug RU 486. 10 (1) All FDA-approved contraceptive drugs, devices, and other products. The following 11 applies to this coverage: 12 (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 13 product, the contract shall include either the original FDA-approved contraceptive drug, device, or 14 product or at least one of its therapeutic equivalents. Therapeutic equivalent shall have the same 15 definition as that set forth by the FDA; 16 (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 17 available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 18 blanket policy shall provide coverage for an alternate therapeutic equivalent version of the 19 contraceptive drug, device, or product, based on the determination of the health care provider, 20 without cost-sharing; and 21 (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- 22 counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 23 over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 24 management restrictions; 25 (2) Voluntary sterilization procedures; 26 (3) Clinical services related to the provision or use of contraception, including 27 consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 28 education, referrals, and counseling; and 29 (4) Follow-up services related to the drugs, devices, products, and procedures covered 30 under this section, including, but not limited to, management of side effects, counseling for 31 continued adherence, and device insertion and removal. 32 (b) A group or blanket policy subject to this section shall not impose a deductible, 33 coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 34 to this section. For a qualifying high-deductible health plan for a health savings account, the carrier LC004206 - Page 9 of 15 1 shall establish the plan s cost-sharing for the coverage provided pursuant to this section at the 2 minimum level necessary to preserve the enrollee s ability to claim tax-exempt contributions and 3 withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 4 impose utilization control or other forms of medical management limiting the supply of FDA- 5 approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 6 location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 7 than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 8 such coverage other than a pharmacy claim. 9 (c) Except as otherwise authorized under this section, a group or blanket policy shall not 10 impose any restrictions or delays on the coverage required under this section. 11 (d) Benefits for an enrollee under this section shall be the same for an enrollee s covered 12 spouse or domestic partner and covered non-spouse dependents. 13 (b) (e) Notwithstanding any other provision of this section, any health maintenance 14 corporation may issue to a religious employer an individual or group health insurance contract, 15 plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to 16 the religious employer’s bona fide religious tenets. The exclusion from coverage under this 17 subsection shall not apply to contraceptive services or procedures provided for purposes other than 18 contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of 19 menopause. 20 (c) (f) As used in this section, “religious employer” means an employer that is a “church or 21 a qualified church-controlled organization” as defined in 26 U.S.C. § 3121. 22 (d) (g) Every religious employer that invokes the exemption provided under this section 23 shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the 24 contraceptive healthcare services the employer refuses to cover for religious reasons. 25 (e) (h) Beginning on the first day of each plan year after April 1, 2019, every health 26 insurance issuer offering group or individual health insurance coverage that covers prescription 27 contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive 28 up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once 29 or over the course of the twelve (12) month period at the discretion of the prescriber . 30 (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 31 devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 32 ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 33 preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 34 accordance with § 27-41-21. The commissioner may base its determinations on findings from LC004206 - Page 10 of 15 1 onsite surveys, enrollee or other complaints, financial status, or any other source. 2 (j) The commissioner shall monitor plan compliance in accordance with this section and 3 shall adopt rules and regulations for the implementation of this section, including the following: 4 (1) In addition to any requirements under state administrative procedures, the 5 commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations 6 that include health care service plans, pharmacy benefit plans, consumer representatives, including 7 those representing youth, low-income people, and communities of color, and other interested 8 parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to 9 ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage. 10 The commissioner shall provide notice of stakeholder meetings on the commissioner s website, and 11 stakeholder meetings shall be open to the public. 12 (2) The commissioner shall conduct random reviews of each plan and its subcontractors to 13 ensure compliance with this section. 14 (3) The commissioner shall submit an annual report to the general assembly and any other 15 appropriate entity with its findings from the random compliance reviews detailed in this section 16 and any other compliance or implementation efforts. This report shall be made available to the 17 public on the commissioner s website. 18 SECTION 5. Chapter 40-8 of the General Laws entitled Medical Assistance is hereby 19 amended by adding thereto the following section: 20 40-8-33. F.D.A. approved prescription contraceptive drugs and devices. 21 (a) Every individual or group health insurance contract, plan, or policy issued pursuant to 22 this chapter that is delivered, issued for delivery, renewed, amended or effective in this state on or 23 after January 1, 2027 shall provide coverage for all of the following services and contraceptive 24 methods. Provided, that nothing in this subsection shall be deemed to mandate or require coverage 25 for the prescription drug RU 486. 26 (1) All FDA-approved contraceptive drugs, devices, and other products. The following 27 applies to this coverage: 28 (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or 29 product, the contract shall include either the original FDA-approved contraceptive drug, device, or 30 product or at least one of its therapeutic equivalents. Therapeutic equivalent shall have the same 31 definition as that set forth by the FDA; 32 (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not 33 available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or 34 blanket policy shall provide coverage for an alternate therapeutic equivalent version of the LC004206 - Page 11 of 15 1 contraceptive drug, device, or product, based on the determination of the health care provider, 2 without cost-sharing; and 3 (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the- 4 counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for 5 over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical 6 management restrictions; 7 (2) Voluntary sterilization procedures; 8 (3) Clinical services related to the provision or use of contraception, including 9 consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient 10 education, referrals, and counseling; and 11 (4) Follow-up services related to the drugs, devices, products, and procedures covered 12 under this section, including, but not limited to, management of side effects, counseling for 13 continued adherence, and device insertion and removal. 14 (b) A group or blanket policy subject to this section shall not impose a deductible, 15 coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant 16 to this section. For a qualifying high-deductible health plan for a health savings account, the carrier 17 shall establish the plan s cost-sharing for the coverage provided pursuant to this section at the 18 minimum level necessary to preserve the enrollee s ability to claim tax-exempt contributions and 19 withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not 20 impose utilization control or other forms of medical management limiting the supply of FDA- 21 approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a 22 location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less 23 than a twelve (12) month supply, and shall not require an enrollee to make any formal request for 24 such coverage other than a pharmacy claim. 25 (c) Except as otherwise authorized under this section, a group or blanket policy shall not 26 impose any restrictions or delays on the coverage required under this section. 27 (d) Benefits for an enrollee under this section shall be the same for an enrollee s covered 28 spouse or domestic partner and covered non-spouse dependents. 29 (e) Notwithstanding any other provision of this section, any health maintenance 30 corporation may issue to a religious employer an individual or group health insurance contract, 31 plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to 32 the religious employer s bona fide religious tenets. The exclusion from coverage under this 33 subsection shall not apply to contraceptive services or procedures provided for purposes other than 34 contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of LC004206 - Page 12 of 15 1 menopause. 2 (f) As used in this section, religious employer means an employer that is a church or a 3 qualified church-controlled organization as defined in 26 U.S.C. § 3121. 4 (g) Every religious employer that invokes the exemption provided under this section shall 5 provide written notice to prospective enrollees prior to enrollment with the plan, listing the 6 contraceptive health care services the employer refuses to cover for religious reasons. 7 (h) Beginning on the first day of each plan year after April 1, 2024, every health insurance 8 issuer offering group or individual health insurance coverage that covers prescription contraception 9 shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three 10 hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the 11 course of the twelve (12) month period at the discretion of the prescriber. 12 (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, 13 devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of 14 ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to 15 preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in 16 accordance with § 40-8-9. The executive office of health and human services may base its 17 determinations on findings from onsite surveys, enrollee or other complaints, financial status, or 18 any other source. 19 (j) The executive office of health and human services shall monitor plan compliance in 20 accordance with this section and shall adopt and regulations rules for the implementation of this 21 section, including the following: 22 (1) In addition to any requirements under state administrative procedures, the executive 23 office of health and human services shall engage in a stakeholder process prior to the adoption of 24 rules and regulations that include health care service plans, pharmacy benefit plans, consumer 25 representatives, including those representing youth, low-income people, and communities of color, 26 and other interested parties. The executive office of health and human services shall hold 27 stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider 28 factors and processes relevant to contraceptive coverage. The executive office of health and human 29 services shall provide notice of stakeholder meetings on the executive office of health and human 30 services website, and stakeholder meetings shall be open to the public. 31 (2) The executive office of health and human services shall conduct random reviews of 32 each plan and its subcontractors to ensure compliance with this section. 33 (3) The executive office of health and human services shall submit an annual report to the 34 general assembly and any other appropriate entity with its findings from the random compliance LC004206 - Page 13 of 15 1 reviews detailed in this section and any other compliance or implementation efforts. This report 2 shall be made available to the public on the executive office of health and human services website. 3 SECTION 6. This act shall take effect upon passage. ======== LC004206 ======== LC004206 - Page 14 of 15 EXPLANATION BY THE LEGISLATIVE COUNCIL OF A N A C T RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES *** 1 This act would require every individual or group health insurance contract effective on or 2 after January 1, 2027, to provide coverage to the insured and the insured s spouse and dependents 3 for all FDA-approved contraceptive drugs, devices and other products, voluntary sterilization 4 procedures, patient education and counseling on contraception and follow-up services as well as 5 Medicaid coverage for a twelve (12) month supply for Medicaid recipients. 6 This act would take effect upon passage. ======== LC004206 ======== LC004206 - Page 15 of 15
Every fact on this page links to its source, starting with the official bill record.