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SB 1053 removes exclusions to contraceptive drugs, devices, and other services | Johnson & Dugan
SB1053 requires plans for underwritten groups (excluding religious employers) to cover contraceptive drugs, devices, and other services
As a result of the passage of California Senate Bill 1053 (SB 1053), as of January 1, 2016, Blue Shield non-grandfathered medical plans for any fully underwritten groups (excluding religious employers, defined as houses of worship) must cover all FDA-approved contraceptive drugs, devices, and other products and services for women. The previously permitted exclusions for religious-affiliated groups of surgical sterilization and counseling about contraception will no longer be permitted.
SB 1053 will serve to align the requirements under existing California law with the federal requirement to cover contraceptive drugs, devices and services with no cost-sharing under the Affordable Care Act preventive services regulations.
The bill provides that a healthcare service plan contract or policy for major medical coverage shall provide coverage for all of the following services and contraceptive methods for women as preventive services with no cost-sharing (deductibles, copay’s, etc.):
1. All FDA-approved contraceptive drugs, devices, and other products for women, including all FDA-approved contraceptive drugs, devices, and products available over the counter, as prescribed by the enrollee’s provider. (Previously state law required coverage only of prescription drugs and devices.) Religious employers remain exempt from this requirement.
2. Voluntary sterilization procedures for women (but not vasectomy for men).
3. Patient education and counseling on contraception.
4. Follow-up services related to contraceptive drugs, devices, products, and procedures including management of side effects, counseling for continued adherence, and device insertion and removal.
Further, as a result of SB 1053, Blue Shield is required to cover all FDA-approved contraceptive drugs and devices for ALL medical plans, not just those with an outpatient prescription drug benefit. This means that as of January 1, 2016, if an employer with Blue Shield medical coverage carves out its pharmacy benefits to another carrier or administrator, Blue Shield must nonetheless cover contraceptive drugs and devices as part of the employer’s medical plan.
SB 1053 is effective for any healthcare service plan contract or policy issued, amended, or renewed on or after January 1, 2016.
How Blue Shield is educating your customers
Tomorrow, April 15, 2015, Blue Shield will notify all Core Accounts employer groups about SB 1053 using the notification referenced below.
Blue Shield has identified all religious-affiliated or other employer groups that currently exclude coverage for any of the identified services, and employer groups that currently carve out their pharmacy benefits to another carrier or administrator. As part of their renewal communications, we will educate them about SB 1053-related changes. In addition, we will identify changes that will take effect for the group beginning with their 2016 renewal. Contracts or policies for these groups will be amended upon renewal on or after January 1, 2016to remove any exclusions for contraceptive services required by SB 1053.
