GENERAL ASSEMBLY OF NORTH CAROLINA
Short Title: Conscience Protection/Contraceptives.
Sponsors: Representatives Wood; and Hilton.
Referred to: Health. March 25, 2003
A BILL TO BE ENTITLED AN ACT TO PROVIDE EFFECTIVE CONSCIENCE PROTECTION
IN THE INSURANCE LAW PERTAINING TO COVERAGE FOR PRESCRIPTION CONTRACEPTIVE
DRUGS OR DEVICES AND FOR OUTPATIENT
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 58-3-178 reads as rewritten:
"§ 58-3-178. Coverage for prescription contraceptive drugs or devices and
for outpatient contraceptive services; exemption for religious employers.
(a)Except as provided in subsection (e)(e1) of this section, every insurer
providing a health benefit plan that provides coverage for prescription
drugs or devices shall provide coverage for prescription contraceptive drugs
or devices. Coverage shall include coverage for the insertion or removal of
and any medically necessary examination associated with the use of the
prescribed contraceptive drug or device. Except as otherwise provided in
this subsection, the same deductibles, coinsurance, and other limitations as
apply to prescription drugs or devices covered under the health benefit plan
shall apply to coverage for prescribed contraceptive drugs or devices. A
health benefit plan may require that the total coinsurance, based on the
useful life of the drug or device, be paid in advance for those drugs
or devices that are inserted or prescribed and do not have to be refilled on
a periodic basis.
(b) Every insurer providing a health benefit plan that provides coverage
for outpatient services provided by a health care professional shall provide
coverage for outpatient contraceptive services. The same deductibles,
coinsurance, and other limitations as apply to outpatient services covered
under the health benefit plan shall apply to coverage for outpatient
(c) As used in this section, the term:
(1) "Health benefit plan" means an accident and health
insurance policy or certificate; a nonprofit hospital or medical service
corporation contract; a health maintenance organization subscriber contract;
a plan provided by a multiple employer welfare arrangement; or a plan
provided by another benefit arrangement, to the extent permitted by the
Employee Retirement Income Security Act of 1974, as amended, or by any
waiver of or other exception to that Act provided under federal law or
"Health benefit plan" does not mean any plan implemented
or administered by the North Carolina Department of Health and Human
Services or the United States Department of Health and Human Services, or
any successor agency, or its representatives.
"Health benefit plan" also does not mean any of the
following kinds of insurance:
c. Disability income.
d. Long-term care or nursing home care.
e. Medicare supplement.
f. Specified disease.
g. Dental or vision.
h. Coverage issued as a supplement to liability insurance.
i. Workers' compensation.
j. Medical payments under automobile or homeowners.
k. Hospital income or indemnity.
l. Insurance under which benefits are payable with or without regard to
fault and that is statutorily required to be contained in any liability
policy or equivalent self-insurance.
m. Short-term limited duration health insurance policies as defined in
Part 144 of Title 45 of the Code of Federal Regulations.
(2) "Insurer" includes an insurance company subject to
this Chapter, a service corporation organized under Article 65 of this
Chapter, a health maintenance organization organized under Article 67 of
this Chapter, and a multiple employer welfare arrangement subject to Article
49 of this Chapter.
(3) "Outpatient contraceptive services" means
consultations, examinations, procedures, and medical services provided on an
outpatient basis and related to the use of contraceptive methods to prevent
pregnancy. The term "outpatient contraceptive services" does not include
medical services, drugs, or devices used in a manner to induce an abortion.
(4) "Prescribed contraceptive drugs or devices" means
drugs or devices that prevent pregnancy and that are approved by the United
States Food and Drug Administration for use as contraceptives and obtained
under a prescription written by a health care provider authorized to
prescribe medications under the laws of this State. Prescription drugs or
devices required to be covered under this section shall not include:
a. The prescription drug known as "RU-486" or any "equivalent drug
product" as defined in G.S.90-85.27(1).
b. The prescription drug marketed under the name "Preven" or any
"equivalent drug product" as defined in G.S. 90-85.27(1).
c. Any drug or device that interferes with the development of an
embryo after fertilization.
(d) A health benefit plan subject to this section shall not do any of the
(1) Deny eligibility or continued eligibility to enroll or to renew
coverage under the terms of the health benefit plan, solely for the
purpose of avoiding the requirements of this section.
(2) Provide monetary payments or rebates to an ndividual participant or
beneficiary to encourage the individual participant or beneficiary to
accept less than the minimum protections available under this section.
(3) Penalize or otherwise reduce or limit the reimbursement of an
attending provider because the provider prescribed contraceptive drugs
or devices, or provided contraceptive services in accordance with this
(4) Provide incentives, monetary or otherwise, to an attending provider
to induce the provider to withhold from an individual participant or
beneficiary contraceptive drugs, devices, or services.
(e) A religious employer may request an insurer providing a health
benefit plan to provide to the religious employer a health benefit plan that
excludes coverage for prescription contraceptive drugs or devices that are
contrary to the employer's religious tenets. Upon request,
the insurer shall provide the requested health benefit plan. An insurer
providing a health benefit plan requested by a religious employer pursuant
to this section shall provide written notice to each person covered under
the health benefit plan that prescription contraceptive drugs or devices are
excluded from coverage pursuant to this section at the request of the
employer. The notice shall appear, in not less than 10-point type, in the
health benefit plan, application, and sales brochure for the health benefit
plan. Nothing in this subsection
authorizes a health benefit plan to exclude coverage for prescription drugs
ordered by a health care provider with prescriptive authority for reasons
other than contraceptive purposes, or for prescription contraception that is
necessary to preserve the life or health of a person covered under the plan.
As used in this subsection, the term "religious employer" means an entity
for which all of the following are true:
(1) The entity is organized and operated for religious purposes and is
tax exempt under section 501(c)(3) of the U.S. Internal Revenue Code.
(2) The inculcation of religious values is one of the primary purposes of
(3) The entity employs primarily persons who share the religious tenets of
the entity. (1999-231, s. 1; 1999-456, s.15(a).)
(e1) Nothing in this section shall be construed to require a health
insurer, employer, or association to provide prescription contraceptive
coverage or outpatient contraceptive services coverage in a health insurance
policy when the provision of the coverage is contrary to the religious
beliefs or moral convictions of the insurer, employer, association, or
insured individual. When a health insurer that provides a health benefit
plan has received from an employer or association certification that the
provision of prescription contraceptive drugs and services as described in
this section is contrary to the religious beliefs or moral convictions of
the employer, organization, association, or employed individual, that
insurer shall provide a plan and charge appropriate premiums without the
inconsistent coverage. An insurer providing a health benefit plan in
response to the certification shall provide reasonable notice that
contraception is not covered in the health benefit plan. This notice shall
be included in any application and sales brochure for the health benefit
SECTION 2. This act is effective when it becomes law.