Insurance Coverage for Contraception
New York 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 prescription medication, it must provide coverage for Food and Drug Administration-approved prescription contraception.
To which insurance plans does the law apply? Group and blanket accident and health-insurance policies, hospital or medical service contracts, and health maintenance organizations (HMOs) that provide coverage for prescription medication.
Does the law provide additional protections for women? Yes. Insurers may only impose reasonable deductibles and coinsurance for contraceptive coverage that are consistent with those established for other medication or devices covered under the policy.
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 contraception is contrary to their religious tenets.
What does the refusal clause allow? A religious employer may require issuers of its health-insurance plans to exclude coverage for contraception.
Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women? No. The law carefully defines the term "religious employer" as a nonprofit organization that has the purpose of inculcating religious values and primarily employs and serves persons who share the religious tenets of the entity. This exemption appropriately applies to religious entities but not broad-based entities that operate in the public sphere.
Does the law require the refusing entity to notify the persons affected? Yes. An employer exercising a refusal clause must provide written notice to prospective enrollees, listing the contraceptive health-care services the employer refuses to cover for religious reasons.
Are there circumstances under which a refusal clause may not be exercised? Yes. A refusal clause may not be used to exclude overage for prescription medication prescribed for reasons other than contraception.
Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause? Yes. When an employer exercises a refusal clause, the insurer must provide enrollees with written notice of their right to directly purchase a rider for contraceptive coverage from the insurer. The notice also must advise enrollees of the additional premium for such coverage.
Has a court considered the constitutionality of this law? Yes. New York state courts held that this law is constitutional under both the federal and state constitutions. Catholic Charities of the Diocese of Albany v. Serio, RJI No. 01-03-072905 (N.Y. Sup. Ct. Nov. 25, 2003), aff'd, 28 A,D,3d 115 (N.Y. App. Div. 2006), aff'd, 7 N.Y.3d 510 (N.Y. 2006), cert. denied sub nom Catholic Charities of the Diocese of Albany v. Dinallo, No. 06-1550 (U.S. Oct. 1, 2007).
N.Y. Ins. Law §§ 3221 (16), 4303, 4322 (Enacted 2002).