376.1199. Coverage for certain obstetrical/gynecological services--exclusion of contraceptive coverage permitted, when--rulemaking authority.
Coverage for certain obstetrical/gynecological services--exclusionof contraceptive coverage permitted, when--rulemaking authority.
376.1199. 1. Each health carrier or health benefit plan that offers orissues health benefit plans providing obstetrical/gynecological benefits andpharmaceutical coverage, which are delivered, issued for delivery, continuedor renewed in this state on or after January 1, 2002, shall:
(1) Notwithstanding the provisions of subsection 4 of section 354.618,RSMo, provide enrollees with direct access to the services of a participatingobstetrician, participating gynecologist or participatingobstetrician/gynecologist of her choice within the provider network forcovered services. The services covered by this subdivision shall be limitedto those services defined by the published recommendations of theaccreditation council for graduate medical education for training anobstetrician, gynecologist or obstetrician/gynecologist, including but notlimited to diagnosis, treatment and referral for such services. A healthcarrier shall not impose additional co-payments, coinsurance or deductiblesupon any enrollee who seeks or receives health care services pursuant to thissubdivision, unless similar additional co-payments, coinsurance or deductiblesare imposed for other types of health care services received within theprovider network. Nothing in this subsection shall be construed to require ahealth carrier to perform, induce, pay for, reimburse, guarantee, arrange,provide any resources for or refer a patient for an abortion, as defined insection 188.015, RSMo, other than a spontaneous abortion or to prevent thedeath of the female upon whom the abortion is performed, or to supersede orconflict with section 376.805; and
(2) Notify enrollees annually of cancer screenings covered by theenrollees' health benefit plan and the current American Cancer Societyguidelines for all cancer screenings or notify enrollees at intervalsconsistent with current American Cancer Society guidelines of cancerscreenings which are covered by the enrollees' health benefit plans. Thenotice shall be delivered by mail unless the enrollee and health carrier haveagreed on another method of notification; and
(3) Include coverage for services related to diagnosis, treatment andappropriate management of osteoporosis when such services are provided by aperson licensed to practice medicine and surgery in this state, forindividuals with a condition or medical history for which bone massmeasurement is medically indicated for such individual. In determiningwhether testing or treatment is medically appropriate, due consideration shallbe given to peer-reviewed medical literature. A policy, provision, contract,plan or agreement may apply to such services the same deductibles, coinsuranceand other limitations as apply to other covered services; and
(4) If the health benefit plan also provides coverage for pharmaceuticalbenefits, provide coverage for contraceptives either at no charge or at thesame level of deductible, coinsurance or co-payment as any other covered drug. No such deductible, coinsurance or co-payment shall be greater than any drugon the health benefit plan's formulary. As used in this section,"contraceptive" shall include all prescription drugs and devices approved bythe federal Food and Drug Administration for use as a contraceptive, but shallexclude all drugs and devices that are intended to induce an abortion, asdefined in section 188.015, RSMo, which shall be subject to section 376.805.Nothing in this subdivision shall be construed to exclude coverage forprescription contraceptive drugs or devices ordered by a health care providerwith prescriptive authority for reasons other than contraceptive or abortionpurposes.
2. For the purposes of this section, "health carrier" and "healthbenefit plan" shall have the same meaning as defined in section 376.1350.
3. The provisions of this section shall not apply to a supplementalinsurance policy, including a life care contract, accident-only policy,specified disease policy, hospital policy providing a fixed daily benefitonly, Medicare supplement policy, long-term care policy, short-term majormedical policies of six months or less duration, or any other supplementalpolicy as determined by the director of the department of insurance, financialinstitutions and professional registration.
4. Notwithstanding the provisions of subdivision (4) of subsection 1 ofthis section to the contrary:
(1) Any health carrier may issue to any person or entity purchasing ahealth benefit plan, a health benefit plan that excludes coverage forcontraceptives if the use or provision of such contraceptives is contrary tothe moral, ethical or religious beliefs or tenets of such person or entity;
(2) Upon request of an enrollee who is a member of a group healthbenefit plan and who states that the use or provision of contraceptives iscontrary to his or her moral, ethical or religious beliefs, any health carriershall issue to or on behalf of such enrollee a policy form that excludescoverage for contraceptives. Any administrative costs to a group healthbenefit plan associated with such exclusion of coverage not offset by thedecreased costs of providing coverage shall be borne by the group policyholderor group plan holder;
(3) Any health carrier which is owned, operated or controlled insubstantial part by an entity that is operated pursuant to moral, ethical orreligious tenets that are contrary to the use or provision of contraceptivesshall be exempt from the provisions of subdivision (4) of subsection 1 of thissection.
For purposes of this subsection, if new premiums are charged for a contract,plan or policy, it shall be determined to be a new contract, plan or policy.
5. Except for a health carrier that is exempted from providing coveragefor contraceptives pursuant to this section, a health carrier shall allowenrollees in a health benefit plan that excludes coverage for contraceptivespursuant to subsection 4 of this section to purchase a health benefit planthat includes coverage for contraceptives.
6. Any health benefit plan issued pursuant to subsection 1 of thissection shall provide clear and conspicuous written notice on the enrollmentform or any accompanying materials to the enrollment form and the group healthbenefit plan contract:
(1) Whether coverage for contraceptives is or is not included;
(2) That an enrollee who is a member of a group health benefit plan withcoverage for contraceptives has the right to exclude coverage forcontraceptives if such coverage is contrary to his or her moral, ethical orreligious beliefs; and
(3) That an enrollee who is a member of a group health benefit planwithout coverage for contraceptives has the right to purchase coverage forcontraceptives.
7. Health carriers shall not disclose to the person or entity whopurchased the health benefit plan the names of enrollees who exclude coveragefor contraceptives in the health benefit plan or who purchase a health benefitplan that includes coverage for contraceptives. Health carriers and theperson or entity who purchased the health benefit plan shall not discriminateagainst an enrollee because the enrollee excluded coverage for contraceptivesin the health benefit plan or purchased a health benefit plan that includescoverage for contraceptives.
8. The departments of health and senior services and insurance,financial institutions and professional registration may promulgate rulesnecessary to implement the provisions of this section. No rule or portion ofa rule promulgated pursuant to this section shall become effective unless ithas been promulgated pursuant to chapter 536, RSMo. Any rule or portion of arule, as that term is defined in section 536.010, RSMo, that is created underthe authority delegated in this section shall become effective only if itcomplies with and is subject to all of the provisions of chapter 536, RSMo,and, if applicable, section 536.028, RSMo. This section and chapter 536,RSMo, are nonseverable and if any of the powers vested with the generalassembly pursuant to chapter 536, RSMo, to review, to delay the effective dateor to disapprove and annul a rule are subsequently held unconstitutional, thenthe grant of rulemaking authority and any rule proposed or adopted afterAugust 28, 2001, shall be invalid and void.
(L. 2001 H.B. 762 merged with S.B. 266)