Coverage of Contraceptive Services

On June 13, 2017, LD 1237 was enacted as Chapter 190 (as a law without the Governor’s signature). Under the new law, coverage for prescription contraceptives and outpatient contraceptive services must include coverage for contraceptive supplies. For this purpose, “contraceptive supplies” means all contraceptive drugs, devices and products approved by the federal Food and Drug Administration (FDA) to prevent unwanted pregnancy. Importantly, coverage must be provided without any deductible, coinsurance, copayment or other cost-sharing requirement for at least one contraceptive supply within each method of contraception that is identified by the FDA to prevent unwanted pregnancy and prescribed by a health care provider.

If there are therapeutic equivalents of contraceptive supplies within FDA-approved contraceptive methods, carriers can provide coverage for more than one contraceptive supply and impose cost-sharing requirements, so long as at least one contraceptive supply within that method is available without cost-sharing. Carriers must defer to a provider’s determination and judgment based on medical necessity and provide coverage for the provider’s recommended FDA-approved contraceptive supplies without cost-sharing. Lastly, plans must provide coverage for dispensing or furnishing contraceptive supplies intended to last for a 12-month period which can be dispensed/furnished all at once or over the course of that 12-month period — at the health care provider’s discretion.

The new law is effective for policies, contracts or certificates issued or renewed in Maine on or after Jan. 1, 2019. There is a religious exemption for employers that are tax-exempt religious organizations – such as churches, conventions and associations of churches or elementary/secondary schools that are controlled by such – if contraceptive use conflicts with that organization’s religious beliefs and practices.

The new law contains no new employer obligations. But employers with fully insured plans in Maine should be aware of the changes in case employees have questions relating to contraceptive coverage.

Chapter 190 »