Maine Revised Statutes Title 24-A Sec. 4247 – Coverage for contraceptives
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(REALLOCATED FROM TITLE 24-A, SECTION 4245)
(REALLOCATED FROM TITLE 24-A, SECTION 4245)
1. Coverage requirements. All health maintenance organization individual and group health contracts that provide coverage for prescription drugs or outpatient medical services must provide coverage for all prescription contraceptives approved by the federal Food and Drug Administration or for outpatient contraceptive services, respectively, to the same extent that coverage is provided for other prescription drugs or outpatient medical services. For purposes of this section, the term “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 an unintended pregnancy. This section may not be construed to apply to prescription drugs or devices that are designed to terminate a pregnancy.
[RR 1999, c. 1, §37 (RAL).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 4247
- Contract: A legal written agreement that becomes binding when signed.
- Copayment: means an amount an enrollee must pay in order to receive a specific service that is not fully prepaid. See Maine Revised Statutes Title 24-A Sec. 4202-A
- Deductible: means the amount an enrollee is responsible to pay out of pocket before a health maintenance organization begins to pay the costs associated with treatment. See Maine Revised Statutes Title 24-A Sec. 4202-A
- Health maintenance organization: means a public or private organization that is organized under the laws of the Federal Government, this State, another state or the District of Columbia or a component of such an organization, and that:
A. See Maine Revised Statutes Title 24-A Sec. 4202-APerson: means an individual, firm, partnership, corporation, association, syndicate, organization, society, business trust, attorney-in-fact or any legal entity. See Maine Revised Statutes Title 24-A Sec. 4202-A Provider: means a physician, hospital or person that is licensed or otherwise authorized in this State to furnish health care services. See Maine Revised Statutes Title 24-A Sec. 4202-A United States: includes territories and the District of Columbia. See Maine Revised Statutes Title 1 Sec. 72
2. Exclusion for religious employer. A religious employer may request and a health maintenance organization shall grant an exclusion under the policy or contract for the coverage required by this section if the required coverage conflicts with the religious employer’s bona fide religious beliefs and practices. A religious employer that obtains an exclusion under this subsection shall provide prospective insureds and those individuals insured under its policy written notice of the exclusion. This section may not be construed as authorizing a health maintenance organization to exclude coverage for prescription drugs prescribed for reasons other than contraceptive purposes or for prescription contraception that is necessary to preserve the life or health of a covered person. For the purposes of this section, “religious employer” means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 United States Code § 3121 (w) (3) (A) and that qualifies as a tax-exempt organization under 26 United States Code § 501(c) (3).
[RR 1999, c. 1, §37 (RAL).]
3. Application. The requirements of this section apply to all individual and group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
[PL 2003, c. 517, Pt. B, §27 (NEW).]
4. Coverage of contraceptive supplies. Coverage required under this section must include coverage for contraceptive supplies in accordance with the following requirements. For purposes of this section, “contraceptive supplies” means all contraceptive drugs, devices and products approved by the federal Food and Drug Administration to prevent an unwanted pregnancy.
A. Coverage must be provided without any deductible, coinsurance, copayment or other cost-sharing requirement. [PL 2021, c. 609, §4 (AMD).]
B. If the federal Food and Drug Administration has approved one or more therapeutic equivalents of a contraceptive supply, a health maintenance organization is not required to cover all those therapeutically equivalent versions in accordance with this subsection, as long as at least one is covered without any deductible, coinsurance, copayment or other cost-sharing requirement in accordance with this subsection. [PL 2021, c. 609, §4 (AMD).]
C. [PL 2021, c. 609, §4 (RP).]
D. Coverage must be provided for the furnishing or dispensing of prescribed contraceptive supplies intended to last for a 12-month period, which may be furnished or dispensed all at once or over the course of the 12 months at the discretion of the health care provider. [PL 2017, c. 190, §3 (NEW).]
[PL 2021, c. 609, §4 (AMD).]
SECTION HISTORY
RR 1999, c. 1, §37 (RAL). PL 2003, c. 517, §B27 (AMD). PL 2017, c. 190, §3 (AMD). PL 2021, c. 609, §4 (AMD).