December 18, 2019
DEPARTMENT OF FINANCIAL SERVICES INSTRUCTS INSURERS TO COMPLY WITH EXPANDED AND STATE-PROTECTED CONTRACEPTIVE COVERAGE
Insurers Must Cover All Included FDA-Approved Contraception, Including Emergency Contraceptives, Cost-Free to Consumers
New Law Applies to Voluntary Sterilization Procedures, Provides Contraceptive Education, Counseling and Follow-Up Services as Needed
Requirements Apply to Health Insurance Policies or Contracts
Issued and Delivered on January 1, 2020 and After
NEW YORK – The Department of Financial Services (DFS) today issued a circular letter to remind and instruct insurers about their responsibilities under the new Comprehensive Contraceptive Coverage Act (CCCA), which will take effect on January 1, 2020. The CCCA codifies current federal preventive care contraceptive requirements, ensuring that even if the federal law is repealed, New Yorkers will still have access to cost-free care and services under New York State law. The law includes coverage without cost-sharing and coverage for over-the-counter (OTC) and emergency contraceptives.
“Thanks to the Governor and the Legislature in partnership with advocacy organizations, New Yorkers will continue to have access to affordable reproductive health care services, regardless of what happens at the federal level,” said Superintendent of Financial Services Lacewell. “DFS reminds insurers to comply with the protections taking effect under this new law, and the Department will take all necessary actions to safeguard the reproductive rights of women in New York.”
Beyond the requirements for health insurers under the federal Affordable Care Act (ACA), the new CCCA:
- Requires coverage without deductible, coinsurance, copayment, or any other cost-sharing requirements for covered contraceptives (whereas federal rules require only one of each of the 18 FDA-approved methods to be covered without cost-sharing);
- Requires coverage for a 12-month supply dispensed at one time to the insured;
- Applies contraceptive coverage requirements to grandfathered health plans; and
- Prohibits any restrictions or delays on coverage, such as preauthorization, step therapy protocols, or quantity limits on a 12-month supply or less.
The law also codifies requirements to cover sterilization procedures, OTC contraceptives, and emergency contraception, patient education and counseling on contraception, and follow-up services related to contraceptive drugs, devices, products, and procedures, all without cost-sharing. In addition, the CCCA allows the insured to gain access to contraceptives not on the insurer’s formulary if the insured’s attending health care provider, in his or her reasonable professional judgment, determines that the use of a non-covered therapeutic or pharmaceutical equivalent of a drug, device, or product is warranted.
The Department will continue to monitor compliance with all contraceptive coverage requirements and may take action against an insurer for any failure to adhere to all statutory or regulatory requirements for contraceptive coverage.
A copy of the Circular Letter can be found on the DFS website.