2025 -- S 0268 SUBSTITUTE A

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LC000242/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Senators Euer, DiMario, Urso, Lauria, Kallman, Valverde, Quezada,
Lawson, Mack, and Sosnowski

     Date Introduced: February 13, 2025

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-57 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-57. F.D.A. approved prescription contraceptive drugs and devices.

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

amended or effective in this state on or after January 1, 2026 shall provide coverage for F.D.A.

approved contraceptive drugs and devices requiring a prescription all of the following services and

contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or

require coverage for the prescription drug RU 486.

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

applies to this coverage:

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

product, the contract shall include either the original FDA-approved contraceptive drug, device, or

product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same

definition as that set forth by the FDA;

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or

blanket policy shall provide coverage for an alternate therapeutic equivalent version of the

contraceptive drug, device, or product, based on the determination of the health care provider,

without cost-sharing; and

     (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-

counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for

over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical

management restrictions;

     (2) Voluntary sterilization procedures;

     (3) Clinical services related to the provision or use of contraception, including

consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient

education, referrals, and counseling; and

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

under this section, including, but not limited to, management of side effects, counseling for

continued adherence, and device insertion and removal.

     (b) A group or blanket policy subject to this section shall not impose a deductible,

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

to this section. For a qualifying high-deductible health plan for a health savings account, the carrier

shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the

minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and

withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not

impose utilization control or other forms of medical management limiting the supply of FDA-

approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a

location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less

than a twelve (12) month supply, and shall not require an enrollee to make any formal request for

such coverage other than a pharmacy claim.

     (c) Except as otherwise authorized under this section, a group or blanket policy shall not

impose any restrictions or delays on the coverage required under this section.

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

spouse or domestic partner and covered non-spouse dependents.

     (b)(e) Notwithstanding any other provision of this section, any insurance company may

issue to a religious employer an individual or group health insurance contract, plan, or policy that

excludes coverage for prescription contraceptive methods that are contrary to the religious

employer’s bona fide religious tenets. The exclusion from coverage under this subsection shall not

apply to contraceptive services or procedures provided for purposes other than contraception, such

as decreasing the risk of ovarian cancer or eliminating symptoms of menopause.

     (c)(f) As used in this section, “religious employer” means an employer that is a “church or

LC000242/SUB A - Page 2 of 14

a qualified church-controlled organization” as defined in 26 U.S.C. § 3121.

     (d)(g) This section does not apply to insurance coverage providing benefits for: (1) Hospital

confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare

supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily

injury or death by accident or both; and (9) Other limited-benefit policies.

     (e)(h) 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 healthcare services the employer refuses to cover for religious reasons.

     (f)(i) Beginning on the first day of each plan year after April 1, 2019, every health insurance

issuer offering group or individual health insurance coverage that covers prescription contraception

shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three

hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the

course of the twelve (12) month period at the discretion of the prescriber.

     (j) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in

accordance with § 27-18-20. The office of the health insurance commissioner ("commissioner")

may base its determinations on findings from onsite surveys, enrollee or other complaints, financial

status, or any other source.

     (k) The commissioner shall monitor plan compliance in accordance with this section and

shall adopt rules and regulations for the implementation of this section, including the following:

     (1) In addition to any requirements under state administrative procedures, the

commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations

that include health care service plans, pharmacy benefit plans, consumer representatives, including

those representing youth, low-income people, and communities of color, and other interested

parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to

ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage.

The commissioner shall provide notice of stakeholder meetings on the department's website, and

stakeholder meetings shall be open to the public.

     (2) The commissioner shall conduct random reviews of each plan and its subcontractors to

ensure compliance with this section.

     (3) The commissioner shall submit an annual report to the general assembly and any other

appropriate entity with its findings from the random compliance reviews detailed in this section

LC000242/SUB A - Page 3 of 14

and any other compliance or implementation efforts. This report shall be made available to the

public on the commissioner's website.

     SECTION 2. Section 27-19-48 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-48. FDA approved prescription contraceptive drugs and devices.

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

amended or effective in this state on or after January 1, 2026 shall provide coverage for FDA

approved contraceptive drugs and devices requiring a prescription all of the following services and

contraceptive methods. Provided, that nothing in this subsection shall be deemed to mandate or

require coverage for the prescription drug RU 486.

      (1) All FDA-approved contraceptive drugs, devices, and other products. The following

applies to this coverage:

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

product, the contract shall include either the original FDA-approved contraceptive drug, device, or

product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same

definition as that set forth by the FDA;

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or

blanket policy shall provide coverage for an alternate therapeutic equivalent version of the

contraceptive drug, device, or product, based on the determination of the health care provider,

without cost-sharing; and

     (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-

counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for

over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical

management restrictions;

     (2) Voluntary sterilization procedures;

     (3) Clinical services related to the provision or use of contraception, including

consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient

education, referrals, and counseling; and

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

under this section, including, but not limited to, management of side effects, counseling for

continued adherence, and device insertion and removal.

     (b) A group or blanket policy subject to this section shall not impose a deductible,

LC000242/SUB A - Page 4 of 14

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

to this section. For a qualifying high-deductible health plan for a health savings account, the carrier

shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the

minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and

withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not

impose utilization control or other forms of medical management limiting the supply of FDA-

approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a

location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less

than a twelve (12) month supply, and shall not require an enrollee to make any formal request for

such coverage other than a pharmacy claim.

     (c) Except as otherwise authorized under this section, a group or blanket policy shall not

impose any restrictions or delays on the coverage required under this section.

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

spouse or domestic partner and covered non-spouse dependents.

     (b)(e) Notwithstanding any other provision of this section, any hospital service corporation

may issue to a religious employer an individual or group health insurance contract, plan, or policy

that excludes coverage for prescription contraceptive methods that are contrary to the religious

employer’s bona fide religious tenets.

     (c)(f) As used in this section, “religious employer” means an employer that is a “church or

a qualified church-controlled organization” as defined in 26 U.S.C. § 3121.

     (d)(g) 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 healthcare services the employer refuses to cover for religious reasons.

     (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health

insurance issuer offering group or individual health insurance coverage that covers prescription

contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive

up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once

or over the course of the twelve (12) month period at the discretion of the prescriber.

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in

accordance with § 27-19-38. The commissioner may base its determinations on findings from

onsite surveys, enrollee or other complaints, financial status, or any other source.

LC000242/SUB A - Page 5 of 14

     (j) The commissioner shall monitor plan compliance in accordance with this section and

shall adopt rules and regulations for the implementation of this section, including the following:

     (1) In addition to any requirements under state administrative procedures, the

commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations

that include health care service plans, pharmacy benefit plans, consumer representatives, including

those representing youth, low-income people, and communities of color, and other interested

parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to

ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage.

The commissioner shall provide notice of stakeholder meetings on the commissioner's website, and

stakeholder meetings shall be open to the public.

     (2) The commissioner shall conduct random reviews of each plan and its subcontractors to

ensure compliance with this section.

     (3) The commissioner shall submit an annual report to the general assembly and any other

appropriate entity with its findings from the random compliance reviews detailed in this section

and any other compliance or implementation efforts. This report shall be made available to the

public on the commissioner's website.

     SECTION 3. Section 27-20-43 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-43. FDA approved prescription contraceptive drugs and devices.

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

amended or effective in this state on or after January 1, 2026 in this state shall provide coverage

for FDA approved contraceptive drugs and devices requiring a prescription all of the following

services and contraceptive methods. Provided, that nothing in this subsection shall be deemed to

mandate or require coverage for the prescription drug RU 486.

     (1) All FDA-approved contraceptive drugs, devices and other products. The following

applies to this coverage:

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

product, the contract shall include either the original FDA-approved contraceptive drug, device, or

product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same

definition as that set forth by the FDA;

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or

blanket policy shall provide coverage for an alternate therapeutic equivalent version of the

LC000242/SUB A - Page 6 of 14

contraceptive drug, device, or product, based on the determination of the health care provider,

without cost-sharing; and

     (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-

counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for

over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical

management restrictions;

     (2) Voluntary sterilization procedures;

     (3) Clinical services related to the provision or use of contraception, including

consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient

education, referrals, and counseling; and

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

under this section, including, but not limited to, management of side effects, counseling for

continued adherence, and device insertion and removal.

     (b) A group or blanket policy subject to this section shall not impose a deductible,

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

to this section. For a qualifying high-deductible health plan for a health savings account, the carrier

shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the

minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and

withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not

impose utilization control or other forms of medical management limiting the supply of FDA-

approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a

location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less

than a twelve (12) month supply, and shall not require an enrollee to make any formal request for

such coverage other than a pharmacy claim.

     (c) Except as otherwise authorized under this section, a group or blanket policy shall not

impose any restrictions or delays on the coverage required under this section.

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

spouse or domestic partner and covered non-spouse dependents.

     (b)(e) Notwithstanding any other provision of this section, any medical service corporation

may issue to a religious employer an individual or group health insurance contract, plan, or policy

that excludes coverage for prescription contraceptive methods that are contrary to the religious

employer’s bona fide religious tenets. The exclusion from coverage under this subsection, shall not

apply to contraceptive services or procedures provided for purposes other than contraception, such

as decreasing the risk of ovarian cancer or eliminating symptoms of menopause.

LC000242/SUB A - Page 7 of 14

     (c)(f) As used in this section, “religious employer” means an employer that is a “church or

a qualified church-controlled organization” as defined in 26 U.S.C. § 3121.

     (d)(g) 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 healthcare services the employer refuses to cover for religious reasons.

     (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health

insurance issuer offering group or individual health insurance coverage that covers prescription

contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive

up to three hundred sixty-five (365) days at a time. that may be furnished or dispensed all at once

or over the course of the twelve (12) month period at the discretion of the prescriber.

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in

accordance with § 27-20-33. The commissioner may base its determinations on findings from

onsite surveys, enrollee or other complaints, financial status, or any other source.

     (j) The commissioner shall monitor plan compliance in accordance with this section and

shall adopt rules and regulations for the implementation of this section, including the following:

     (1) In addition to any requirements under state administrative procedures, the

commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations

that include health care service plans, pharmacy benefit plans, consumer representatives, including

those representing youth, low-income people, and communities of color, and other interested

parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to

ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage.

The commissioner shall provide notice of stakeholder meetings on the commissioner's website, and

stakeholder meetings shall be open to the public.

     (2) The commissioner shall conduct random reviews of each plan and its subcontractors to

ensure compliance with this section.

     (3) The commissioner shall submit an annual report to the general assembly and any other

appropriate entity with its findings from the random compliance reviews detailed in this section

and any other compliance or implementation efforts. This report shall be made available to the

public on the commissioner's website.

     SECTION 4. Section 27-41-59 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

LC000242/SUB A - Page 8 of 14

     27-41-59. FDA approved prescription contraceptive drugs and devices.

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

this title that provides prescription coverage and is delivered, issued for delivery, or renewed,

amended or effective in this state on or after January 1, 2026 shall provide coverage for FDA

approved contraceptive drugs and devices requiring a prescription; provided, all of the following

services and contraceptive methods. Provided, that nothing in this subsection shall be deemed to

mandate or require coverage for the prescription drug RU 486.

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

applies to this coverage:

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

product, the contract shall include either the original FDA-approved contraceptive drug, device, or

product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same

definition as that set forth by the FDA;

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or

blanket policy shall provide coverage for an alternate therapeutic equivalent version of the

contraceptive drug, device, or product, based on the determination of the health care provider,

without cost-sharing; and

     (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-

counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for

over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical

management restrictions;

     (2) Voluntary sterilization procedures;

     (3) Clinical services related to the provision or use of contraception, including

consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient

education, referrals, and counseling; and

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

under this section, including, but not limited to, management of side effects, counseling for

continued adherence, and device insertion and removal.

     (b) A group or blanket policy subject to this section shall not impose a deductible,

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

to this section. For a qualifying high-deductible health plan for a health savings account, the carrier

shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the

minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and

LC000242/SUB A - Page 9 of 14

withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not

impose utilization control or other forms of medical management limiting the supply of FDA-

approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a

location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less

than a twelve (12) month supply, and shall not require an enrollee to make any formal request for

such coverage other than a pharmacy claim.

     (c) Except as otherwise authorized under this section, a group or blanket policy shall not

impose any restrictions or delays on the coverage required under this section.

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

spouse or domestic partner and covered non-spouse dependents.

     (b)(e) Notwithstanding any other provision of this section, any health maintenance

corporation may issue to a religious employer an individual or group health insurance contract,

plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to

the religious employer’s bona fide religious tenets. The exclusion from coverage under this

subsection shall not apply to contraceptive services or procedures provided for purposes other than

contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of

menopause.

     (c)(f) As used in this section, “religious employer” means an employer that is a “church or

a qualified church-controlled organization” as defined in 26 U.S.C. § 3121.

     (d)(g) 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 healthcare services the employer refuses to cover for religious reasons.

     (e)(h) Beginning on the first day of each plan year after April 1, 2019, every health

insurance issuer offering group or individual health insurance coverage that covers prescription

contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive

up to three hundred sixty-five (365) days at a time that may be furnished or dispensed all at once

or over the course of the twelve (12) month period at the discretion of the prescriber.

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in

accordance with § 27-41-21. The commissioner may base its determinations on findings from

onsite surveys, enrollee or other complaints, financial status, or any other source.

     (j) The commissioner shall monitor plan compliance in accordance with this section and

LC000242/SUB A - Page 10 of 14

shall adopt rules and regulations for the implementation of this section, including the following:

     (1) In addition to any requirements under state administrative procedures, the

commissioner shall engage in a stakeholder process prior to the adoption of rules and regulations

that include health care service plans, pharmacy benefit plans, consumer representatives, including

those representing youth, low-income people, and communities of color, and other interested

parties. The commissioner shall hold stakeholder meetings for stakeholders of different types to

ensure sufficient opportunity to consider factors and processes relevant to contraceptive coverage.

The commissioner shall provide notice of stakeholder meetings on the commissioner's website, and

stakeholder meetings shall be open to the public.

     (2) The commissioner shall conduct random reviews of each plan and its subcontractors to

ensure compliance with this section.

     (3) The commissioner shall submit an annual report to the general assembly and any other

appropriate entity with its findings from the random compliance reviews detailed in this section

and any other compliance or implementation efforts. This report shall be made available to the

public on the commissioner's website.

     SECTION 5. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby

amended by adding thereto the following section:

     40-8-33. F.D.A. approved prescription contraceptive drugs and devices.

     (a) Every individual or group health insurance contract, plan, or policy issued pursuant to

this chapter that is delivered, issued for delivery, renewed, amended or effective in this state on or

after January 1, 2026 shall provide coverage for all of the following services and contraceptive

methods. Provided, that nothing in this subsection shall be deemed to mandate or require coverage

for the prescription drug RU 486.

     (1) All FDA-approved contraceptive drugs, devices, and other products. The following

applies to this coverage:

     (i) If there is a therapeutic equivalent of an FDA-approved contraceptive drug, device, or

product, the contract shall include either the original FDA-approved contraceptive drug, device, or

product or at least one of its therapeutic equivalents. "Therapeutic equivalent" shall have the same

definition as that set forth by the FDA;

     (ii) If the covered therapeutic equivalent versions of a drug, device, or product are not

available, or are not tolerated by the patient, or are deemed medically inadvisable, a group or

blanket policy shall provide coverage for an alternate therapeutic equivalent version of the

contraceptive drug, device, or product, based on the determination of the health care provider,

without cost-sharing; and

LC000242/SUB A - Page 11 of 14

     (iii) A plan shall not require a prescription to trigger coverage of FDA-approved over-the-

counter contraceptive drugs, devices, and products, and shall provide point-of-sale coverage for

over-the-counter contraceptives at in-network pharmacies without cost-sharing or medical

management restrictions;

     (2) Voluntary sterilization procedures;

     (3) Clinical services related to the provision or use of contraception, including

consultations, examinations, procedures, device insertion, ultrasound, anesthesia, patient

education, referrals, and counseling; and

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

under this section, including, but not limited to, management of side effects, counseling for

continued adherence, and device insertion and removal.

     (b) A group or blanket policy subject to this section shall not impose a deductible,

coinsurance, copayment or any other cost-sharing requirement on the coverage provided pursuant

to this section. For a qualifying high-deductible health plan for a health savings account, the carrier

shall establish the plan's cost-sharing for the coverage provided pursuant to this section at the

minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions and

withdrawals from their health savings account under 26 U.S.C. § 223. A health plan shall not

impose utilization control or other forms of medical management limiting the supply of FDA-

approved contraception that may be dispensed or furnished by a provider or pharmacist, or at a

location licensed or otherwise authorized to dispense drugs or supplies in an amount that is less

than a twelve (12) month supply, and shall not require an enrollee to make any formal request for

such coverage other than a pharmacy claim.

     (c) Except as otherwise authorized under this section, a group or blanket policy shall not

impose any restrictions or delays on the coverage required under this section.

     (d) Benefits for an enrollee under this section shall be the same for an enrollee's covered

spouse or domestic partner and covered non-spouse dependents.

     (e) Notwithstanding any other provision of this section, any health maintenance

corporation may issue to a religious employer an individual or group health insurance contract,

plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to

the religious employer's bona fide religious tenets. The exclusion from coverage under this

subsection shall not apply to contraceptive services or procedures provided for purposes other than

contraception, such as decreasing the risk of ovarian cancer or eliminating symptoms of

menopause.

     (f) As used in this section, "religious employer" means an employer that is a "church or a

LC000242/SUB A - Page 12 of 14

qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

     (g) 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.

     (h) Beginning on the first day of each plan year after April 1, 2024, every health insurance

issuer offering group or individual health insurance coverage that covers prescription contraception

shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three

hundred sixty-five (365) days at a time that may be furnished or dispensed all at once or over the

course of the twelve (12) month period at the discretion of the prescriber.

     (i) Nothing in this section shall be construed to exclude coverage for contraceptive drugs,

devices, or products for reasons other than contraceptive purposes, such as decreasing the risk of

ovarian cancer or eliminating symptoms of menopause, or for contraception that is necessary to

preserve the life or health of an enrollee. A plan that violates this section is subject to penalties, in

accordance with § 40-8-9. The executive office of health and human services may base its

determinations on findings from onsite surveys, enrollee or other complaints, financial status, or

any other source.

     (j) The executive office of health and human services shall monitor plan compliance in

accordance with this section and shall adopt and regulations rules for the implementation of this

section, including the following:

     (1) In addition to any requirements under state administrative procedures, the executive

office of health and human services shall engage in a stakeholder process prior to the adoption of

rules and regulations that include health care service plans, pharmacy benefit plans, consumer

representatives, including those representing youth, low-income people, and communities of color,

and other interested parties. The executive office of health and human services shall hold

stakeholder meetings for stakeholders of different types to ensure sufficient opportunity to consider

factors and processes relevant to contraceptive coverage. The executive office of health and human

services shall provide notice of stakeholder meetings on the executive office of health and human

services' website, and stakeholder meetings shall be open to the public.

     (2) The executive office of health and human services shall conduct random reviews of

each plan and its subcontractors to ensure compliance with this section.

     (3) The executive office of health and human services shall submit an annual report to the

general assembly and any other appropriate entity with its findings from the random compliance

reviews detailed in this section and any other compliance or implementation efforts. This report

shall be made available to the public on the executive office of health and human services' website.

LC000242/SUB A - Page 13 of 14

     SECTION 6. This act shall take effect upon passage.

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LC000242/SUB A

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LC000242/SUB A - Page 14 of 14

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would require every individual or group health insurance contract effective on or

after January 1, 2026, to provide coverage to the insured and the insured's spouse and dependents

for all FDA-approved contraceptive drugs, devices and other products, voluntary sterilization

procedures, patient education and counseling on contraception and follow-up services as well as

Medicaid coverage for a twelve (12) month supply for Medicaid recipients.

     This act would take effect upon passage.

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LC000242/SUB A

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LC000242/SUB A - Page 15 of 14