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Insurance Coverage

Insurance Coverage for Contraceptives

Insurance plans in Connecticut must fully cover the costs of prescription contraceptives without any copay or deductible, unless an insurer receives a religious exception. When insurers obtain such an exception, they are required to give written notice to the individuals whom they insure.


Federal Laws

Under the Patient Protection and Affordable Care Act (ACA), which passed Congress in 2010 and was upheld by the Supreme Court in 2012, health insurance plans that are created or undergo significant alterations after July 31, 2013, must include coverage for all contraceptives approved by the Food and Drug Administration (FDA) relating to female reproduction (this excludes male condoms and sterilization surgery for men). These contraceptives must be covered by a healthcare provider without out-of pocket cost to the healthcare recipient as long as she has a prescription (the requirement of a prescription includes contraceptives that can be obtained over-the-counter like female condoms and spermicide gel). A complete list of FDA-approved contraceptives can be found here.


In addition to contraceptives, the law requires that insurance providers cover the following services:


  • At least one preventive care visit annually for adults to obtain recommended preventive services.

  • Screening for gestational diabetes.

  • Human papillomavirus (HPV) testing.

  • Counseling on sexually transmitted infections for all sexually active women.

  • Counseling and screening for human immune-deficiency virus (HIV) for all sexually active women.

  • Contraceptive methods approved by the Food and Drug Administration and patient education and counseling.

  • Comprehensive lactation support, counseling, and costs of renting breastfeeding equipment.

  • Screening and counseling for interpersonal and domestic violence for all women and adolescents.


CT Laws

Prior to the passage of the ACA, Connecticut law, like the laws of 27 other states, required health insurance plans that cover prescription drugs to provide the same coverage for contraception. Today, the federal regulations listed above govern contraception insurance coverage in Connecticut.


Exceptions

The ACA provides certain exceptions to its contraceptive insurance coverage requirements. Most often, employers will file for exemption based on bona fide religious belief. When a health insurance plan does not include some or any contraceptive coverage, Connecticut law requires written disclosure to healthcare recipients.



INSURANCE COVERAGE FOR CONTRACEPTION REFUSAL CLAUSE

Although Connecticut law requires health-insurance plans that cover prescription medication to provide equitable coverage for contraception, certain employers and/or insurers may require that their plans exclude coverage for contraception.


To whom does the refusal clause apply? Religious employers for whom prescription contraceptive methods are contrary to their bona fide religious tenets, as well as insurance providers owned, operated, or substantially controlled by a religious organization that has religious or moral tenets that conflict with contraceptive coverage.


What does the refusal clause allow? Upon a religious employer's request, an insurance provider may issue to a religious employer a plan that excludes coverage for contraception. In addition, insurance providers owned, operated, or substantially controlled by a religious organization that has religious or moral tenets that conflict with contraceptive coverage may provide for coverage of prescription contraceptive methods through another entity offering a limited benefit plan, provided that the coverage has the same cost, terms, and availability as other prescription coverage offered to the insured.


Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? Yes. The law broadly defines the term "religious employer" as a church-controlled or church-affiliated organization. This broad definition inappropriately includes entities that operate in the public sphere.


Does the law require that the persons affected by the refusal be notified? Yes. A health-insurance policy that excludes coverage for prescription contraceptive methods due to an employer's religious refusal must provide the insured or prospective insured with written notice of the exclusion.


Are there circumstances under which a refusal clause may not be exercised? Yes. A refusal clause may not be used to exclude coverage for prescription contraceptive methods ordered for reasons other than contraceptive purposes.


Does the law provide a mechanism for women to obtain contraceptive coverage if their employer and/or insurer exercises a refusal clause? No.


May an individual obtain a health-insurance policy that excludes contraceptive coverage? Yes. An individual who states in writing that prescription contraceptive methods are contrary to the individual's religious or moral beliefs may obtain a health-insurance policy from their insurer that excludes coverage for contraception.


Conn. Gen. Stat. Ann. 38a-503e, -530e (Enacted 1999).


 
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