Washington State SB 6219 implementation information

Greetings.

 

In March 2018, the Washington State Legislature passed SB 6219 concerning health plan coverage of reproductive health. The law requires that all health plans issued or renewed on or after January 1, 2019, provide coverage to all enrollees, enrolled spouses and enrolled dependents for the full range of FDA-approved reproductive services, including over-the-counter products.

 

This law also states that:

 

•  A health plan may not require copayments, deductibles, or other forms of cost-sharing for these reproductive services, unless the plan is a qualified health plan for a health savings account (HSA).  For plans that qualify for an HSA, the carrier must establish the plan's cost sharing for these reproductive services at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions and withdrawals from his or her HSA account under the Internal Revenue Service (IRS) laws and regulations. The carrier may not require a prescription to trigger coverage of over-the-counter contraceptive drugs, devices, and products, approved by the federal food and drug administration. 

• The carrier may not deny the required coverage because an enrollee changed his or her contraceptive method within a twelve-month period, and may not impose any restrictions or delays on the coverage such as medical management techniques that limit enrollee choice in accessing the full range of contraceptive drugs, devices, or other products approved by the FDA, except as otherwise authorized under this law. 

• If a health plan issued or renewed on or after January 1, 2019, provides coverage for maternity care, the health plan must also provide substantially equivalent coverage to permit the abortion of a pregnancy. The plan may not limit the way in which a person accesses access services related to the abortion of a pregnancy, except that coverage for the abortion may be subject to terms and conditions generally applicable to the health plan's coverage of maternity care, including applicable cost sharing. A health plan is not required to cover abortions deemed unlawful under RCW 9.02.120.

• A plan cannot deny care on the basis of race, color, national origin, sex, sexual orientation, gender expression or identity, marital status, age, citizenship, immigration status or disability.

 Health plan filings currently under OIC review will receive the following universal objection: 

“Per SB 6219, a health plan issued or renewed on or after January 1, 2019 must provide coverage to enrollees for the following:

• All contraceptive drugs, devices and other products approved by the Federal Food and Drug Administration (FDA), including over-the-counter contraceptive drugs, devices and products;

• Voluntary sterilization procedures;

• All consultations, examinations, procedures and medical services that are necessary to prescribe, dispense, insert, deliver, distribute, administer or remove the drugs, devices and other products or services for the services required to be covered; and

• Plans that cover maternity care or services must also provide substantially equivalent coverage to permit the abortion of a pregnancy.  This coverage may be subject to the terms and conditions (including cost sharing) applicable to the plan’s coverage of maternity care or services.

Carriers may not require a prescription to trigger coverage of over-the-counter contraceptive drugs, devices, and products, approved by the FDA.

Plans may not require cost sharing in any form for these reproductive services, with two exceptions.  First, abortion services may be subject to the cost sharing generally applicable to the plan’s coverage of maternity services.  Second, qualifying health plans for a health savings account (HSA) must have cost sharing at the minimum level necessary to preserve the enrollee’s ability to claim tax exempt contributions and withdrawals from his or her HSA under Internal Revenue Service laws and regulations.

To ensure that consumers are aware of the provisions of SB 6219, notice of this required coverage must be provided to the enrollees within the forms (policy, certificate, and/or schedules) in the appropriate benefit section.

In response, please confirm your plans’ compliance with this law, and explain how the newly-required coverage listed above will be provided.  Please also direct our attention to the location of the language within the forms in this filing that notifies enrollees of this coverage.”

 

If you have any questions regarding these requirements, please contact Andrea Philhower at AndreaP@oic.wa.gov.