contraceptive equity

Contraceptive Equity requires health insurance plans that cover prescription drugs to include coverage for prescription contraceptives. Though most health insurance plans provide coverage for prescription drugs and devices, many deliberately exclude coverage for the most used: contraceptives. Contraceptive Equity is about fairness, preventing gender discrimination, and access to basic health care.

Governor Doyle Signed State Budget & Contraceptive Equity into Law!
On June 29, 2009 Governor Doyle signed the state budget and the 3 prevention first initiatives into law: Contraceptive Equity, Prescription Protection, and expansion of the Family Planning Waiver! Contraceptive Equity went into effect on January 1, 2010.

As a Matter of Gender Equity, Prescription Drug Plans Must Include Contraceptives

• Family planning information and services are basic health care for women during at least three decades of their lives.
• Most women spend approximately 30 years trying to post-pone or avoid pregnancy.
• Over 90% of women use at least one kind of contraceptive method during their lifetime.
• Excluding birth control coverage under prescription drug plans singles out women, because only women use prescription birth control.
• Because of the lack of coverage, women spend 68% more in out-of-pocket health care costs than men.
• Historically, it has taken state laws to ensure that health insurance plans to cover women’s health issues. Advocates have secured insurance mandates in WI that require coverage of maternity and newborn care; coverage of mammograms and breast reconstruction surgery; and direct access to obstetricians and gynecologists.
• 40% of women who are at risk for an unintended pregnancy say they have problems accessing birth control.
• The National Business Group on Health, an organization representing over 160 large national and multi-national employers, has estimated that failing to provide contraceptive coverage actually costs employers 15-17% more than providing the coverage (Promoting Healthy Pregnancies: Counseling and Contraception as the First Step; Family Health in Brief, 2000).

The Contraceptive Equity law went into effect on January 1, 2010. This law requires insurance plans that provide prescription drug benefits to also include coverage for contraceptives.

The Office of the Commissioner of Insurance in Wisconsin sent out a memo to Insurers:  http://oci.wi.gov/bulletin/0709act28.htm

Section 632.895 (17) was created to require coverage for contraceptives and services in all disability insurance policies and self-insured health plans of the state or of a county, city, town, village, or school district, that provide coverage for outpatient health care services, preventive treatments and services, or prescription drugs and devices, including limited service health organizations, preferred provider plans and defined network plans, as follows:

• Coverage for contraceptives prescribed by a health care provider;
• Coverage for outpatient consultations, examinations, procedures, and medical services, if covered for any other drug benefits under the policy or plan;
• Coverage may only be subject to the exclusions, limitations, and cost-sharing provisions that apply generally to the applicable coverage under the policy or plan;

This requirement does not apply to:

• A disability policy that covers only certain specified diseases;
• A health care plan offered by a limited service health organization or by a preferred provider plan that is not a defined network plan;
• A long-term care insurance policy; or
• A Medicare replacement or a Medicare supplement policy.

The above provisions take effect on January 1, 2010. 

Employees and employers can contact the Office of the Commissioner of Insurance for further information or questions: 608-266-3585