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Insurance Coverage & Contraception

Supports Insurance Coverage of Contraception

Connecticut law requires health-insurance plans that cover prescription medication to provide equitable coverage for contraception.

What is required?  If a health-insurance plan provides coverage for outpatient prescription medication, it must provide coverage for Food and Drug Administration-approved prescription contraception.

To which insurance plans does the law apply?  Individual and group health-insurance policies issued or renewed on or after October 1, 1999 that provide coverage for outpatient prescription medication.

Does the law contain a refusal clause, allowing certain employers and/or insurers to refuse to provide or pay for contraceptive coverage?  Yes.

To whom does the refusal clause apply?  Religious employers for whom prescription contraception is 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 contraception 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 defines the term “religious employer” as a church-controlled or church-affiliated organization.  This 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 contraception 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 contraception 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 contraception is contrary to his/her 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).

Low-Income Women & Contraception

Supports Low-Income Women’s Access to Contraception

Connecticut provides increased access to reproductive-health-care services through a State Plan Amendment (SPA) to its Medicaid program.  The SPA allows the state to cover family-planning services for women and men with family incomes at or below 263 percent of the federal poverty level who are not currently enrolled in Medicaid and do not have any other health insurance.  Additionally, enrollees must be (1) U.S. citizens or persons who meet the state’s defined immigration requirements and (2) Connecticut residents.

Beneficiaries of family-planning coverage available through the SPA are not required to pay premiums or co-payments for covered services.  Covered services include: all FDA-approved birth-control methods, devices and supplies; a comprehensive reproductive-health history, physical examination, and pap smear; emergency services directly related to the contraceptive method and follow-up; pregnancy testing and counseling; prevention and treatment of sexually transmitted infections; HIV testing and counseling; male and female sterilization; reproductive-health education and counseling.

Connecticut State Plan Amendment, 12-009, Family Planning Services.  Modified income eligibility.  CT Husky Health Limited Benefit Member Letter.

Emergency Contraception

EC in the ER

Connecticut law ensures that sexual-assault survivors receive access to emergency contraception (EC) in hospital emergency rooms.  As part of the minimum standards for the examination and treatment of a sexual-assault survivor, a physician or other health-care provider must provide a sexual-assault survivor with medically and factually accurate information about EC, offer her EC, and provide EC to her upon request.  Hospitals are allowed to administer pregnancy tests and if the test is positive, the hospital does not have to provide the woman with EC.

Hospitals are also allowed to contract with an “independent provider” defined as a physician, physician assistant, advanced practice registered nurse or registered nurse, or a nurse-midwife to ensure compliance with the law.  Conn. Gen. Stat. Ann § 19a-112e (Enacted 2007).

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