Guidance on Coverage of Contraceptive Services Under NY Law

On Jan. 21, 2017, the New York (NY) Department of Financial Services (DFS) published Supplement No. 1 to Insurance Circular Letter No. 1 (2003). The new supplemental bulletin is directed towards insurers and relates to contraceptive services provided through health insurance coverage, including student health plans. As background, under NY law, insurers that provide prescription drug coverage must provide coverage for all U.S. Food and Drug Administration (FDA)-approved contraceptive drugs and devices (or generic equivalents). In addition, NY law requires all non-grandfathered plans to include coverage for preventive care and screenings, including contraceptive drugs and devices, without cost-sharing.

Similar requirements apply under federal law (PPACA), and the bulletin reiterates that the NY law applies regardless of PPACA’s application (although both NY law and PPACA rely on the same sources in determining what coverage is considered preventive—namely the Health Resources and Services Administration and the FDA).

The bulletin confirms the types of FDA-approved contraceptives that must be covered, including sterilization surgery for women, surgical sterilization implant for women, implantable rod, IUD copper, IUD with progestin, shots or injections, oral contraceptives (combined pill, progestin, extended/continuous use), patch, vaginal contraceptive ring, diaphragm, sponge, cervical cap, female condom, spermicide and emergency contraception (Plan B, One Step/Next/Choice/My Way, and Ella). In addition, the plan must cover follow-up and management of side effects relating to the contraceptive services and devices and any device removal (all without cost-sharing). The bulletin also states that insurers must provide complete and accurate information regarding contraceptive coverage to insureds and prospective insureds.

For employers, the bulletin does not include new compliance obligations, but does re-emphasize the importance of properly providing preventive services (including contraceptive devices) with zero cost-sharing. The bulletin also highlights the importance of state law with respect to the future of PPACA: If PPACA is repealed some state laws may continue (if they’ve been adopted into the state insurance or other code). Overall, though, employers with fully insured plans in NY should work with their insurers to better understand the coverage requirements with respect to contraceptive coverage.

Supplement No. 1 to Insurance Circular Letter No. 1 (2003) »