Missouri Revised Statutes
Chapter 376
Life, Health and Accident Insurance
←376.1192
Section 376.1199.1
376.1200→
August 28, 2015
Coverage for certain obstetrical/gynecological services--exclusion of contraceptive coverage permitted, when--rulemaking authority.
376.1199. 1. Each health carrier or health benefit plan that offers or
issues health benefit plans providing obstetrical/gynecological benefits and
pharmaceutical coverage, which are delivered, issued for delivery, continued
or renewed in this state on or after January 1, 2002, shall:
(1) Notwithstanding the provisions of subsection 4 of section 354.618,
provide enrollees with direct access to the services of a participating
obstetrician, participating gynecologist or participating
obstetrician/gynecologist of her choice within the provider network for
covered services. The services covered by this subdivision shall be limited
to those services defined by the published recommendations of the
accreditation council for graduate medical education for training an
obstetrician, gynecologist or obstetrician/gynecologist, including but not
limited to diagnosis, treatment and referral for such services. A health
carrier shall not impose additional co-payments, coinsurance or deductibles
upon any enrollee who seeks or receives health care services pursuant to this
subdivision, unless similar additional co-payments, coinsurance or deductibles
are imposed for other types of health care services received within the
provider network. Nothing in this subsection shall be construed to require a
health carrier to perform, induce, pay for, reimburse, guarantee, arrange,
provide any resources for or refer a patient for an abortion, as defined in
section 188.015, other than a spontaneous abortion or to prevent the death of
the female upon whom the abortion is performed, or to supersede or conflict
with section 376.805; and
(2) Notify enrollees annually of cancer screenings covered by the
enrollees' health benefit plan and the current American Cancer Society
guidelines for all cancer screenings or notify enrollees at intervals
consistent with current American Cancer Society guidelines of cancer
screenings which are covered by the enrollees' health benefit plans. The
notice shall be delivered by mail unless the enrollee and health carrier have
agreed on another method of notification; and
(3) Include coverage for services related to diagnosis, treatment and
appropriate management of osteoporosis when such services are provided by a
person licensed to practice medicine and surgery in this state, for
individuals with a condition or medical history for which bone mass
measurement is medically indicated for such individual. In determining
whether testing or treatment is medically appropriate, due consideration shall
be given to peer-reviewed medical literature. A policy, provision, contract,
plan or agreement may apply to such services the same deductibles, coinsurance
and other limitations as apply to other covered services; and
(4) If the health benefit plan also provides coverage for pharmaceutical
benefits, provide coverage for contraceptives either at no charge or at the
same level of deductible, coinsurance or co-payment as any other covered drug.
No such deductible, coinsurance or co-payment shall be greater than any drug
on the health benefit plan's formulary. As used in this section,
"contraceptive" shall include all prescription drugs and devices approved by
the federal Food and Drug Administration for use as a contraceptive, but shall
exclude all drugs and devices that are intended to induce an abortion, as
defined in section 188.015, which shall be subject to section 376.805.
Nothing in this subdivision shall be construed to exclude coverage for
prescription contraceptive drugs or devices ordered by a health care provider
with prescriptive authority for reasons other than contraceptive or abortion
purposes.
2. For the purposes of this section, "health carrier" and "health
benefit plan" shall have the same meaning as defined in section 376.1350.
3. The provisions of this section shall not apply to a supplemental
insurance policy, including a life care contract, accident-only policy,
specified disease policy, hospital policy providing a fixed daily benefit
only, Medicare supplement policy, long-term care policy, short-term major
medical policies of six months or less duration, or any other supplemental
policy as determined by the director of the department of insurance, financial
institutions and professional registration.
4. Notwithstanding the provisions of subdivision (4) of subsection 1 of
this section to the contrary:
(1) Any health carrier shall offer and issue to any person or entity
purchasing a health benefit plan, a health benefit plan that excludes coverage
for contraceptives if the use or provision of such contraceptives is contrary
to the moral, ethical or religious beliefs or tenets of such person or entity;
(2) Upon request of an enrollee who is a member of a group health
benefit plan and who states that the use or provision of contraceptives is
contrary to his or her moral, ethical or religious beliefs, any health carrier
shall issue to or on behalf of such enrollee a policy form that excludes
coverage for contraceptives. Any administrative costs to a group health
benefit plan associated with such exclusion of coverage not offset by the
decreased costs of providing coverage shall be borne by the group policyholder
or group plan holder;
(3) Any health carrier which is owned, operated or controlled in
substantial part by an entity that is operated pursuant to moral, ethical or
religious tenets that are contrary to the use or provision of contraceptives
shall be exempt from the provisions of subdivision (4) of subsection 1 of this
section. For purposes of this subsection, if new premiums are charged for a
contract, plan or policy, it shall be determined to be a new contract, plan or
policy.
5. Except for a health carrier that is exempted from providing coverage
for contraceptives pursuant to this section, a health carrier shall allow
enrollees in a health benefit plan that excludes coverage for contraceptives
pursuant to subsection 4 of this section to purchase a health benefit plan
that includes coverage for contraceptives.
6. Any health benefit plan issued pursuant to subsection 1 of this
section shall provide clear and conspicuous written notice on the enrollment
form or any accompanying materials to the enrollment form and the group health
benefit plan application and contract:
(1) Whether coverage for contraceptives is or is not included;
(2) That an enrollee who is a member of a group health benefit plan with
coverage for contraceptives has the right to exclude coverage for
contraceptives if such coverage is contrary to his or her moral, ethical or
religious beliefs;
(3) That an enrollee who is a member of a group health benefit plan
without coverage for contraceptives has the right to purchase coverage for
contraceptives;
(4) Whether an optional rider for elective abortions has been purchased
by the group contract holder pursuant to section 376.805; and
(5) That an enrollee who is a member of a group health plan with
coverage for elective abortions has the right to exclude and not pay for
coverage for elective abortions if such coverage is contrary to his or her
moral, ethical, or religious beliefs.
For purposes of this subsection, if new premiums are charged for a contract,
plan, or policy, it shall be determined to be a new contract, plan, or policy.
7. Health carriers shall not disclose to the person or entity who
purchased the health benefit plan the names of enrollees who exclude coverage
for contraceptives in the health benefit plan or who purchase a health benefit
plan that includes coverage for contraceptives. Health carriers and the
person or entity who purchased the health benefit plan shall not discriminate
against an enrollee because the enrollee excluded coverage for contraceptives
in the health benefit plan or purchased a health benefit plan that includes
coverage for contraceptives.
8. The departments of health and senior services and insurance,
financial institutions and professional registration may promulgate rules
necessary to implement the provisions of this section. No rule or portion of
a rule promulgated pursuant to this section shall become effective unless it
has been promulgated pursuant to chapter 536. Any rule or portion of a rule,
as that term is defined in section 536.010, that is created under the
authority delegated in this section shall become effective only if it complies
with and is subject to all of the provisions of chapter 536 and, if
applicable, section 536.028. This section and chapter 536 are nonseverable
and if any of the powers vested with the general assembly pursuant to chapter
536 to review, to delay the effective date or to disapprove and annul a rule
are subsequently held unconstitutional, then the grant of rulemaking authority
and any rule proposed or adopted after August 28, 2001, shall be invalid and
void.
(L. 2001 H.B. 762 merged with S.B. 266, A.L. 2012 S.B. 749)
*Effective 10-12-12, see § 21.250. S.B. 749 was vetoed on July 12,
2012. The veto was overridden on September 12, 2012.
(2013) Subsections 1(4), 4, 5, 6(1), 6(2), and 6(3) of section are
pre-empted by the federal Affordable Care Act and its
implementing regulations. Missouri Insurance Coalition v. Huff,
947 F.Supp.2d 1014 (E.D.Mo.).
2001
2001
376.1199. 1. Each health carrier or health benefit plan that offers or
issues health benefit plans providing obstetrical/gynecological benefits and
pharmaceutical coverage, which are delivered, issued for delivery, continued
or renewed in this state on or after January 1, 2002, shall:
(1) Notwithstanding the provisions of subsection 4 of section 354.618,
provide enrollees with direct access to the services of a participating
obstetrician, participating gynecologist or participating
obstetrician/gynecologist of her choice within the provider network for
covered services. The services covered by this subdivision shall be limited
to those services defined by the published recommendations of the
accreditation council for graduate medical education for training an
obstetrician, gynecologist or obstetrician/gynecologist, including but not
limited to diagnosis, treatment and referral for such services. A health
carrier shall not impose additional co-payments, coinsurance or deductibles
upon any enrollee who seeks or receives health care services pursuant to this
subdivision, unless similar additional co-payments, coinsurance or
deductibles are imposed for other types of health care services received
within the provider network. Nothing in this subsection shall be construed to
require a health carrier to perform, induce, pay for, reimburse, guarantee,
arrange, provide any resources for or refer a patient for an abortion, as
defined in section 188.015, other than a spontaneous abortion or to prevent
the death of the female upon whom the abortion is performed, or to supersede
or conflict with section 376.805; and
(2) Notify enrollees annually of cancer screenings covered by the
enrollees' health benefit plan and the current American Cancer Society
guidelines for all cancer screenings or notify enrollees at intervals
consistent with current American Cancer Society guidelines of cancer
screenings which are covered by the enrollees' health benefit plans. The
notice shall be delivered by mail unless the enrollee and health carrier have
agreed on another method of notification; and
(3) Include coverage for services related to diagnosis, treatment and
appropriate management of osteoporosis when such services are provided by a
person licensed to practice medicine and surgery in this state, for
individuals with a condition or medical history for which bone mass
measurement is medically indicated for such individual. In determining
whether testing or treatment is medically appropriate, due consideration
shall be given to peer-reviewed medical literature. A policy, provision,
contract, plan or agreement may apply to such services the same deductibles,
coinsurance and other limitations as apply to other covered services; and
(4) If the health benefit plan also provides coverage for pharmaceutical
benefits, provide coverage for contraceptives either at no charge or at the
same level of deductible, coinsurance or co-payment as any other covered drug.
No such deductible, coinsurance or co-payment shall be greater than any drug
on the health benefit plan's formulary. As used in this section,
"contraceptive" shall include all prescription drugs and devices approved by
the federal Food and Drug Administration for use as a contraceptive, but shall
exclude all drugs and devices that are intended to induce an abortion, as
defined in section 188.015, which shall be subject to section 376.805.
Nothing in this subdivision shall be construed to exclude coverage for
prescription contraceptive drugs or devices ordered by a health care provider
with prescriptive authority for reasons other than contraceptive or abortion
purposes.
2. For the purposes of this section, "health carrier" and "health benefit
plan" shall have the same meaning as defined in section 376.1350.
3. The provisions of this section shall not apply to a supplemental
insurance policy, including a life care contract, accident-only policy,
specified disease policy, hospital policy providing a fixed daily benefit
only, Medicare supplement policy, long-term care policy, short-term major
medical policies of six months or less duration, or any other supplemental
policy as determined by the director of the department of insurance,
financial institutions and professional registration.
4. Notwithstanding the provisions of subdivision (4) of subsection 1 of
this section to the contrary:
(1) Any health carrier may issue to any person or entity purchasing a
health benefit plan, a health benefit plan that excludes coverage for
contraceptives if the use or provision of such contraceptives is contrary to
the moral, ethical or religious beliefs or tenets of such person or entity;
(2) Upon request of an enrollee who is a member of a group health
benefit plan and who states that the use or provision of contraceptives is
contrary to his or her moral, ethical or religious beliefs, any health
carrier shall issue to or on behalf of such enrollee a policy form that
excludes coverage for contraceptives. Any administrative costs to a group
health benefit plan associated with such exclusion of coverage not offset by
the decreased costs of providing coverage shall be borne by the group
policyholder or group plan holder;
(3) Any health carrier which is owned, operated or controlled in
substantial part by an entity that is operated pursuant to moral, ethical or
religious tenets that are contrary to the use or provision of contraceptives
shall be exempt from the provisions of subdivision (4) of subsection 1 of this
section.
For purposes of this subsection, if new premiums are charged for a contract,
plan or policy, it shall be determined to be a new contract, plan or policy.
5. Except for a health carrier that is exempted from providing coverage
for contraceptives pursuant to this section, a health carrier shall allow
enrollees in a health benefit plan that excludes coverage for contraceptives
pursuant to subsection 4 of this section to purchase a health benefit plan
that includes coverage for contraceptives.
6. Any health benefit plan issued pursuant to subsection 1 of this
section shall provide clear and conspicuous written notice on the enrollment
form or any accompanying materials to the enrollment form and the group health
benefit plan contract:
(1) Whether coverage for contraceptives is or is not included;
(2) That an enrollee who is a member of a group health benefit plan with
coverage for contraceptives has the right to exclude coverage for
contraceptives if such coverage is contrary to his or her moral, ethical or
religious beliefs; and
(3) That an enrollee who is a member of a group health benefit plan
without coverage for contraceptives has the right to purchase coverage for
contraceptives.
7. Health carriers shall not disclose to the person or entity who
purchased the health benefit plan the names of enrollees who exclude coverage
for contraceptives in the health benefit plan or who purchase a health
benefit plan that includes coverage for contraceptives. Health carriers and
the person or entity who purchased the health benefit plan shall not
discriminate against an enrollee because the enrollee excluded coverage for
contraceptives in the health benefit plan or purchased a health benefit plan
that includes coverage for contraceptives.
8. The departments of health and senior services and insurance, financial
institutions and professional registration may promulgate rules necessary to
implement the provisions of this section. No rule or portion of a rule
promulgated pursuant to this section shall become effective unless it has
been promulgated pursuant to chapter 536. Any rule or portion of a rule, as
that term is defined in section 536.010, that is created under the authority
delegated in this section shall become effective only if it complies with and
is subject to all of the provisions of chapter 536 and, if applicable,
section 536.028. This section and chapter 536 are nonseverable and if any of
the powers vested with the general assembly pursuant to chapter 536 to
review, to delay the effective date or to disapprove and annul a rule are
subsequently held unconstitutional, then the grant of rulemaking authority and
any rule proposed or adopted after August 28, 2001, shall be invalid and void.
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