Connecticut Seal

General Assembly

File No. 242

    January Session, 2017

Substitute Senate Bill No. 586

Senate, March 27, 2017

The Committee on Insurance and Real Estate reported through SEN. LARSON of the 3rd Dist. and SEN. KELLY of the 21st Dist., Chairpersons of the Committee on the part of the Senate, that the substitute bill ought to pass.

AN ACT EXPANDING MANDATED HEALTH BENEFITS FOR WOMEN, CHILDREN AND ADOLESCENTS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective January 1, 2018) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for:

(1) Domestic and interpersonal violence screening and counseling for any woman;

(2) Tobacco use intervention and cessation counseling for any woman who consumes tobacco;

(3) Well-woman visits for any woman who is younger than sixty-five years of age;

(4) Breast cancer chemoprevention counseling for any woman who is at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by such woman's physician or advanced practice registered nurse;

(5) Breast cancer risk assessment, genetic testing and counseling;

(6) Chlamydia infection screening for any sexually active woman;

(7) Cervical and vaginal cancer screening for any sexually active woman;

(8) Gonorrhea screening for any sexually active woman;

(9) Human immunodeficiency virus screening for any sexually active woman;

(10) Human papillomavirus screening for any woman with normal cytology results who is thirty years of age or older;

(11) Sexually transmitted infections counseling for any sexually active woman;

(12) Anemia screening for any pregnant woman and any woman who is likely to become pregnant;

(13) Folic acid supplements for any pregnant woman and any woman who is likely to become pregnant;

(14) Hepatitis B screening for any pregnant woman;

(15) Rhesus incompatibility screening for any pregnant woman and follow-up rhesus incompatibility testing for any pregnant woman who is at increased risk for rhesus incompatibility;

(16) Syphilis screening for any pregnant woman and any woman who is at increased risk for syphilis;

(17) Urinary tract and other infection screening for any pregnant woman;

(18) Breastfeeding support and counseling for any pregnant or breastfeeding woman;

(19) Breastfeeding supplies, including, but not limited to, a breast pump for any breastfeeding woman;

(20) Gestational diabetes screening for any woman who is twenty-four to twenty-eight weeks pregnant and any woman who is at increased risk for gestational diabetes; and

(21) Osteoporosis screening for any woman who is sixty years of age or older.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 2. (NEW) (Effective January 1, 2018) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for:

(1) Domestic and interpersonal violence screening and counseling for any woman;

(2) Tobacco use intervention and cessation counseling for any woman who consumes tobacco;

(3) Well-woman visits for any woman who is younger than sixty-five years of age;

(4) Breast cancer chemoprevention counseling for any woman who is at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by such woman's physician or advanced practice registered nurse;

(5) Breast cancer risk assessment, genetic testing and counseling;

(6) Chlamydia infection screening for any sexually active woman;

(7) Cervical and vaginal cancer screening for any sexually active woman;

(8) Gonorrhea screening for any sexually active woman;

(9) Human immunodeficiency virus screening for any sexually active woman;

(10) Human papillomavirus screening for any woman with normal cytology results who is thirty years of age or older;

(11) Sexually transmitted infections counseling for any sexually active woman;

(12) Anemia screening for any pregnant woman and any woman who is likely to become pregnant;

(13) Folic acid supplements for any pregnant woman and any woman who is likely to become pregnant;

(14) Hepatitis B screening for any pregnant woman;

(15) Rhesus incompatibility screening for any pregnant woman and follow-up rhesus incompatibility testing for any pregnant woman who is at increased risk for rhesus incompatibility;

(16) Syphilis screening for any pregnant woman and any woman who is at increased risk for syphilis;

(17) Urinary tract and other infection screening for any pregnant woman;

(18) Breastfeeding support and counseling for any pregnant or breastfeeding woman;

(19) Breastfeeding supplies, including, but not limited to, a breast pump for any breastfeeding woman;

(20) Gestational diabetes screening for any woman who is twenty-four to twenty-eight weeks pregnant and any woman who is at increased risk for gestational diabetes; and

(21) Osteoporosis screening for any woman who is sixty years of age or older.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 3. (NEW) (Effective January 1, 2018) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for prescription drugs shall provide coverage for immunizations recommended by the American Academy of Pediatrics, American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 4. (NEW) (Effective January 1, 2018) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for prescription drugs shall provide coverage for immunizations recommended by the American Academy of Pediatrics, American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 5. (NEW) (Effective January 1, 2018) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for preventive care and screenings for individuals twenty-one years of age or younger in accordance with the most recent edition of the American Academy of Pediatrics' "Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents".

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 6. (NEW) (Effective January 1, 2018) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for preventive care and screenings for individuals twenty-one years of age or younger in accordance with the most recent edition of the American Academy of Pediatrics' "Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents".

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 7. Section 38a-503e of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2018):

(a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [that provides coverage for outpatient prescription drugs approved by the federal Food and Drug Administration shall not exclude coverage for prescription contraceptive methods approved by the federal Food and Drug Administration.] shall provide coverage for the following contraceptive methods and services:

(1) All contraceptive methods approved by the federal Food and Drug Administration;

(2) All sterilization methods approved by the federal Food and Drug Administration;

(3) Counseling in (A) contraceptive methods approved by the federal Food and Drug Administration, and (B) the proper use of contraceptive equipment and supplies approved by the federal Food and Drug Administration; and

(4) Routine follow-up care concerning contraceptive methods, equipment and supplies approved by the federal Food and Drug Administration.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493.

(c) No insurance company, hospital service corporation, medical service corporation, health care center or other entity providing coverage of the type specified in subsection (a) of this section may use step therapy, as defined in section 38a-510, or require prior authorization for the benefits and services required under subsection (a) of this section.

[(b)] (d) (1) Notwithstanding any other provision of this section, any insurance company, hospital service corporation, medical service corporation, or health care center may issue to a religious employer an individual health insurance policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer's bona fide religious tenets.

(2) Notwithstanding any other provision of this section, upon the written request of an individual who states in writing that prescription contraceptive methods are contrary to such individual's religious or moral beliefs, any insurance company, hospital service corporation, medical service corporation or health care center may issue to the individual an individual health insurance policy that excludes coverage for prescription contraceptive methods.

[(c)] (e) Any health insurance policy issued pursuant to subsection [(b)] (d) of this section shall provide written notice to each insured or prospective insured that prescription contraceptive methods are excluded from coverage pursuant to said subsection. Such notice shall appear, in not less than ten-point type, in the policy, application and sales brochure for such policy.

[(d)] (f) Nothing in this section shall be construed as authorizing an individual health insurance policy to exclude coverage for prescription drugs ordered by a health care provider with prescriptive authority for reasons other than contraceptive purposes.

[(e)] (g) Notwithstanding any other provision of this section, any insurance company, hospital service corporation, medical service corporation or health care center that is owned, operated or substantially controlled by a religious organization that has religious or moral tenets that conflict with the requirements of this section may provide for the coverage of prescription contraceptive methods as required under this section through another such entity offering a limited benefit plan. The cost, terms and availability of such coverage shall not differ from the cost, terms and availability of other prescription coverage offered to the insured.

[(f)] (h) As used in this section, "religious employer" means an employer that is a "qualified church-controlled organization" as defined in 26 USC 3121 or a church-affiliated organization.

Sec. 8. Section 38a-530e of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2018):

(a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [that provides coverage for outpatient prescription drugs approved by the federal Food and Drug Administration shall not exclude coverage for prescription contraceptive methods approved by the federal Food and Drug Administration.] shall provide coverage for the following contraceptive methods and services:

(1) All contraceptive methods approved by the federal Food and Drug Administration;

(2) All sterilization methods approved by the federal Food and Drug Administration;

(3) Counseling in (A) contraceptive methods approved by the federal Food and Drug Administration, and (B) the proper use of contraceptive equipment and supplies approved by the federal Food and Drug Administration; and

(4) Routine follow-up care concerning contraceptive methods, equipment and supplies approved by the federal Food and Drug Administration.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493.

(c) No insurance company, hospital service corporation, medical service corporation, health care center or other entity providing coverage of the type specified in subsection (a) of this section may use step therapy, as defined in section 38a-510, or require prior authorization for the benefits and services required under subsection (a) of this section.

[(b)] (d) (1) Notwithstanding any other provision of this section, any insurance company, hospital service corporation, medical service corporation or health care center may issue to a religious employer a group health insurance policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer's bona fide religious tenets.

(2) Notwithstanding any other provision of this section, upon the written request of an individual who states in writing that prescription contraceptive methods are contrary to such individual's religious or moral beliefs, any insurance company, hospital service corporation, medical service corporation or health care center may issue to or on behalf of the individual a policy or rider thereto that excludes coverage for prescription contraceptive methods.

[(c)] (e) Any health insurance policy issued pursuant to subsection [(b)] (d) of this section shall provide written notice to each insured or prospective insured that prescription contraceptive methods are excluded from coverage pursuant to said subsection. Such notice shall appear, in not less than ten-point type, in the policy, application and sales brochure for such policy.

[(d)] (f) Nothing in this section shall be construed as authorizing a group health insurance policy to exclude coverage for prescription drugs ordered by a health care provider with prescriptive authority for reasons other than contraceptive purposes.

[(e)] (g) Notwithstanding any other provision of this section, any insurance company, hospital service corporation, medical service corporation or health care center that is owned, operated or substantially controlled by a religious organization that has religious or moral tenets that conflict with the requirements of this section may provide for the coverage of prescription contraceptive methods as required under this section through another such entity offering a limited benefit plan. The cost, terms and availability of such coverage shall not differ from the cost, terms and availability of other prescription coverage offered to the insured.

[(f)] (h) As used in this section, "religious employer" means an employer that is a "qualified church-controlled organization" as defined in 26 USC 3121 or a church-affiliated organization.

This act shall take effect as follows and shall amend the following sections:

Section 1

January 1, 2018

New section

Sec. 2

January 1, 2018

New section

Sec. 3

January 1, 2018

New section

Sec. 4

January 1, 2018

New section

Sec. 5

January 1, 2018

New section

Sec. 6

January 1, 2018

New section

Sec. 7

January 1, 2018

38a-503e

Sec. 8

January 1, 2018

38a-530e

INS

Joint Favorable Subst.

 

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.


OFA Fiscal Note

State Impact: None

Municipal Impact:

Municipalities

Effect

FY 18 $

FY 19 $

Various Municipalities

Potential Cost

See Below

See Below

Explanation

The bill is not anticipated to result in a cost to the state employee and retiree health plan or fully-insured, non-grandfathered municipal plans to comply with the coverage provisions in the bill. These plans provide coverage for the services specified in the bill pursuant to state or federal law. The only exception is with regards to prohibiting step therapy for contraceptives for certain municipal plans. There may be a cost to fully-insured municipal plans (both non-grandfathered and grandfathered) which require step therapy. The cost will depend on the cost of the drugs used under step therapy as opposed to those prescribed without step therapy.

The bill may result in a cost to certain fully-insured grandfathered plans which do not currently provide coverage for those services required by the federal Affordable Care Act but not mandated by state law, such as breast feeding supplies. The coverage requirements will result in increased premium costs when municipalities enter into new health insurance contracts after January 1, 2018.

Pursuant to federal law, self-insured health plans are exempt from state health mandates.

The Out Years

The annualized potential fiscal impact identified above will continue in the future and will be reflected in future health premiums.

OLR Bill Analysis

sSB 586

AN ACT EXPANDING MANDATED HEALTH BENEFITS FOR WOMEN, CHILDREN AND ADOLESCENTS.

SUMMARY

This bill requires certain health insurance policies to cover specified women's health care services, including contraception; immunizations for children, adolescents, and adults; and preventive services for children and youth age 21 or younger. The services must be covered in full with no cost sharing (such as coinsurance, copayments, or deductibles). The cost-sharing prohibition does not apply to high deductible health plans designed to be compatible with federally qualified health savings accounts.

Currently, health insurance policies, except grandfathered ones, must cover these services with no cost sharing pursuant to Section 2713 of the federal Patient Protection and Affordable Care Act (P. L. 111-148, as amended). Grandfathered policies are those that were in existence before March 23, 2010 that have not made significant changes to their coverage.

The bill applies to individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; or (4) hospital or medical services, including those provided under an HMO plan. Because of the federal Employee Retirement Income Security Act (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.

EFFECTIVE DATE: January 1, 2018

1 & 2 — WOMEN'S HEALTH SERVICES

Under the bill, health insurance policies must cover the following services:

3 & 4 — IMMUNIZATIONS

The bill requires health insurance policies that cover prescription drugs to also cover immunizations for children, adolescents, and adults that are recommended by the American Academy of Pediatrics, American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists. These include immunizations such as influenza, meningitis, tetanus, HPV, hepatitis A and B, measles, mumps, rubella, and varicella.

5 & 6 — PREVENTIVE SERVICES FOR CHILDREN AND YOUTH

The bill requires health insurance policies to cover preventive services for people age 21 or younger in accordance with the most recent edition of the American Academy of Pediatrics' Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. These include services such as behavioral and developmental assessments; iron and fluoride supplements; and screening for autism, vision or hearing impairment, lipid disorders, and tuberculosis.

Existing law, unchanged by the bill, requires group health insurance policies to cover preventive pediatric care for a child up to age six (CGS 38a-535).

7 & 8 — CONTRACEPTIVE METHODS AND SERVICES

Current law requires health insurance policies that cover outpatient prescription drugs approved by the U.S. Food and Drug Administration (FDA) to also cover FDA-approved contraceptive methods.

The bill instead requires health insurance policies to cover the following contraceptive methods and services:

The bill prohibits health carriers (e.g., insurers and HMOs) from imposing step therapy or prior authorization requirements on these contraceptive methods and services. (Step therapy is a protocol establishing the sequence for prescribing drugs that generally requires patients to try less expensive drugs before higher cost drugs.)

Under existing law and unchanged by the bill, religious employers and individuals may request that their insurance policies not cover prescriptive contraceptive methods if they are contrary to their bona fide religious tenets.

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable Substitute

Yea

20

Nay

0

(03/09/2017)

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