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Current Status Bill Number:View additional legislative information at the LPITS web site.3310 Type of Legislation:General Bill GB Introducing Body:House Introduced Date:20010123 Primary Sponsor:Cobb-Hunter All Sponsors:Cobb-Hunter and Stuart Drafted Document Number:l:\council\bills\gjk\20121sd01.doc Residing Body:House Current Committee:Labor, Commerce and Industry Committee 26 HLCI Subject:Medical and health insurance policies, not to exclude contraceptive drugs or devices, outpatient services, when History Body Date Action Description Com Leg Involved ______ ________ ______________________________________ _______ ____________ House 20010123 Introduced, read first time, 26 HLCI referred to Committee Versions of This Bill
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-142 SO AS TO PROHIBIT AN INDIVIDUAL OR GROUP HEALTH AND ACCIDENT INSURANCE POLICY OR A HEALTH MAINTENANCE ORGANIZATION PLAN TO EXCLUDE OR RESTRICT BENEFITS FOR FEDERALLY APPROVED CONTRACEPTIVE DRUGS OR DEVICES OR FOR OUTPATIENT CONTRACEPTIVE SERVICES IF THE POLICY OR PLAN PROVIDES BENEFITS FOR OTHER OUTPATIENT PRESCRIPTION DRUGS, DEVICES, OR SERVICES, AND TO PROHIBIT SUCH POLICY OR PLAN FROM DISCRIMINATING AGAINST INDIVIDUALS AND HEALTH CARE PROFESSIONALS FOR USE OF SUCH CONTRACEPTIVE BENEFITS, FROM OFFERING REBATES OR INCENTIVES TO DISCOURAGE SUCH USE, OR FROM IMPOSING DIFFERENT DEDUCTIBLES, COINSURANCE, OR OTHER COST SHARING OR LIMITATIONS FROM OTHER OUTPATIENT DRUGS, DEVICES, OR SERVICES UNDER THE PLAN.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. The 1976 Code is amended by adding:
"Section 38-71-142. (A) An individual or group health and accident health insurance policy or a health maintenance organization plan may not:
(1) exclude or restrict benefits for prescription contraceptive drugs or devices approved by the United States Food and Drug Administration, or generic equivalents approved as substitutable by the United States Food and Drug Administration, if the policy or plan provides benefits for other outpatient prescription drugs or devices; or
(2) exclude or restrict benefits for outpatient contraceptive services if the policy or plan provides benefits for other outpatient services provided by a health care professional.
(B) An individual or group health and accident insurance policy or a health maintenance organization plan may not:
(1) deny to an individual eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the policy or plan because of the individual's or enrollee's use or potential use of items or services that are covered in accordance with the requirements of this section;
(2) provide monetary payments or rebates to a covered individual to encourage the individual to accept less than the minimum protections available under this section;
(3) penalize or otherwise reduce or limit the reimbursement of a health care professional because the professional prescribed contraceptive drugs or devices, or provided contraceptive services in accordance with this section; or
(4) provide incentives, monetary or otherwise, to a health care professional to induce the professional to withhold from a covered individual contraceptive drugs or devices or contraceptive services.
(C) Nothing in this section may be construed as:
(1) preventing an individual or group health and accident insurance policy or a health maintenance organization plan from imposing deductibles, coinsurance, or other cost sharing or limitations in relation to:
(a) benefits for contraceptive drugs under the policy or plan, except that a deductible, coinsurance, or other cost sharing or limitation for any contraceptive drug may not be greater than a deductible, coinsurance, or cost sharing or limitation for any outpatient prescription drug otherwise covered under the policy or plan;
(b) benefits for contraceptive devices under the policy or plan, except that a deductible, coinsurance, or other cost sharing or limitation for any contraceptive device may not be greater than a deductible, coinsurance, or cost sharing or limitation for any outpatient prescription device otherwise covered under the policy or plan; and
(c) benefits for outpatient contraceptive services under the policy or plan, except that a deductible coinsurance, or other cost sharing or limitation for any outpatient contraceptive service may not be greater than a deductible, coinsurance, or cost sharing or limitation for any outpatient health care service otherwise covered under the policy or plan; and
(2) requiring an individual or group health and accident insurance policy or a health maintenance organization plan to cover experimental or investigational contraceptive drugs or devices or experimental or investigational contraceptive services, except to the extent that the policy or plan provides coverage for other experimental or investigational outpatient prescription drugs or devices, or experimental or investigational outpatient health care services.
(D) As used in this section:
(1) 'outpatient contraceptive services' means consultants consultations, examinations, procedures, and medical services, provided on an outpatient basis and related to the use of contraceptive methods, including natural family planning, to prevent an unintended pregnancy;
(2) 'limitation' means in the case of:
(a) a contraceptive drug or device, restricting the type of health care professionals that may prescribe the drugs or devices, placing greater utilization review provisions on use of these devices, or limiting the volume of prescription drugs or devices that may be obtained on the basis of a single consultation with a professional; or
(b) an outpatient contraceptive service, restricting the type of health care professionals that may provide the services, placing greater utilization review provisions on these services, or placing additional requirements on obtaining second opinions prior to the coverage of the services or on preauthorizations prior to the coverage of the services."
SECTION 2. This act takes effect upon approval by the Governor and applies to individual and group accident and health insurance policies and health maintenance organization plans issued or renewed after July 1, 2001.
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