New Guidance on Health Insurance Coverage for Contraceptive Services

On December 18, 2019, the Department of Financial Services published Supplement No. 3 to Insurance Circular Letter No. 1 (2003), which relates to health insurance coverage for contraceptive services. The bulletin states that Chapters 25 and 27 (new laws enacted in 2019) make changes to New York insurance laws that apply to contracts issued, amended, renewed, effective, or delivered on or after January 1, 2020.

Chapters 25 and 27 require fully insured plans (including grandfathered plans) to provide coverage for all contraceptive drugs, devices, and products approved by the FDA. This includes all FDA-approved over-the-counter contraceptive drugs, devices and other products as prescribed or as otherwise authorized under state or federal law that are provided for in federal guidelines. This also includes voluntary sterilization; patient education and counseling on contraception; follow-up services related to contraceptive drugs, devices, products, and other procedures (including management of side effects, counseling for continued adherence, and device insertion and removal); and prescription and over-the-counter emergency contraception.

That said, where the FDA has approved one or more therapeutic and pharmaceutical equivalent versions of a contraceptive drug, device, or product, the carrier is not required to include all of the therapeutic and pharmaceutical equivalent versions in its formulary, so long as at least one is included and covered without cost-sharing. Carriers do have to allow for the dispensing of the entire 12-month supply of a contraceptive at the same time, and may not impose any restrictions or delay on the coverage (such as preauthorization, step-therapy protocols, or quantity limits on a 12-month supply or less).

The bulletin requires no new employer compliance obligations. But employers with fully insured plans in NY should be aware of the new contraceptive coverage requirements. 

Supplement No. 3 to Insurance Circular Letter No. 1 (2003) »