Pre-filed December 1, 1999, and 1000 copies ordered printed.
AN ACT
To amend chapter 376, RSMo, relating to health insurance by adding thereto eight new sections relating to the same subject with an effective date.
Section A. Chapter 376, RSMo, is amended by adding thereto eight new sections, to be known as sections 376.1420, 376.1423, 376.1426, 376.1429, 376.1432, 376.1435, 376.1438, and 376.1442, to read as follows:
376.1420. Sections 376.1420 to 376.1442 shall be known and may be cited as the "Equity in Prescription Insurance and Contraceptive Coverage Act of 2000".
376.1423. As used in sections 376.1420 to 376.1442, the following terms shall mean:
(1) "Covered person", a policyholder, subscriber, certificate holder, enrollee or other individual who is participating in or receiving coverage pursuant to a health insurance plan;
(2) "Health insurance plan", any individual or group plan, policy, certificate, subscriber contract, contract of insurance provided by a managed care plan, preferred provider agreement or health maintenance organization subscriber contract that is delivered, issued, renewed, modified, amended or extended by a health insurer in this state that pays for or purchases health care services to covered persons;
(3) "Health insurer", a disability insurer, health care insurer, health maintenance organization, accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, health service corporation, health care service plan, preferred provider organization or arrangement, or multiple employer welfare arrangement;
(4) "Outpatient contraceptive services", consultations, examinations, procedures and medical services provided on an outpatient basis and related to the use of contraceptive methods to prevent pregnancy.
376.1426. 1. Every health insurance plan that provides benefits for prescription drugs or devices shall not exclude or restrict benefits to covered persons for any prescription contraceptive drugs or devices approved by the federal Food and Drug Administration.
2. Every health insurance plan that provides benefits for outpatient services provided by a health care professional shall not exclude or restrict outpatient contraceptive services for covered persons.
376.1429. A health insurance plan shall not:
(1) Impose a deductible, coinsurance, or other cost-sharing or waiting period in relation to benefits for prescription contraceptive drugs or devices under a health insurance plan, unless such deductible, coinsurance, other cost-sharing or waiting period for such contraceptive drugs and devices is no greater than such deductibles, coinsurance, cost-sharing or waiting periods for other prescription drugs or devices covered under the health insurance plan;
(2) Impose a deductible, coinsurance, or other cost-sharing or waiting period in relation to benefits for outpatient contraceptive services under a health insurance plan, unless such a deductible, coinsurance, or other cost-sharing or waiting period for such contraceptive services is no greater than such deductibles, coinsurance, or cost-sharing or waiting periods for other outpatient services covered under the health insurance plan;
(3) Deny to any individual or covered person eligibility, or continued eligibility, to enroll or renew coverage pursuant to the terms of the plan because of such individual's or covered person's use or potential use of items or services that are covered in accordance with the requirements of sections 376.1420 to 376.1442;
(4) Provide monetary payments or rebates to a covered person to encourage such person to accept less than the minimum protections available pursuant to sections 376.1420 to 376.1442;
(5) Penalize, or otherwise reduce or limit the reimbursement of a health care professional because such professional prescribed contraceptive drugs, devices or provided contraceptive services in accordance with sections 376.1420 to 376.1442;
(6) Provide incentives, monetary or otherwise, to a health care professional to induce such professional to withhold from a covered person contraceptive drugs, devices or contraceptive services;
(7) Exclude or restrict benefits to covered persons or other individuals covered by a private health insurance plan for seeking prescription contraceptive drugs, devices or services related to covered contraceptives from any provider licensed to offer such services in this state.
376.1432. The director of the department of insurance shall receive and review complaints regarding the compliance with sections 376.1420 to 376.1442. The director may use all investigatory tools available to the director to verify compliance with sections 376.1420 to 376.1442. If the director determines that a health insurance plan is not in compliance with sections 376.1420 to 376.1442, the director shall:
(1) Recommend a correction plan that shall be followed by the health insurer;
(2) Institute corrective action that shall be followed by the health insurer;
(3) Suspend or revoke the certificate of authority, or deny the health insurer's application for a certificate of authority; or
(4) Use any of the director's enforcement powers to obtain the health insurer's compliance with sections 376.1420 to 376.1442.
376.1435. If any provision, word, phrase or clause of sections 376.1420 to 376.1442, or the application thereof, to any person, entity or circumstance is held invalid, such invalidity shall not affect the remaining provisions, words, phrases or clauses of sections 376.1420 to 376.1442 which can be given effect without the invalid provision, word, phrase or clause, or application thereof, and to this end, the provisions, words, phrases or clauses of sections 376.1420 to 376.1442 are declared severable.
376.1438. Sections 376.1420 to 376.1442 shall not apply to a health insurance plan in force on January 1, 2001, but shall apply to any health insurance plan that is delivered, issued, renewed, modified, amended, or extended on or after January 1, 2001.
376.1442. The provisions of sections 376.1420 to 376.1442 shall become effective January 1, 2001.
Missouri House of Representatives