Prescribed Female Contraceptive Drugs or Devices; Insurance Coverage

  1. Law
  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Prescribed Female Contraceptive Drugs or Devices; Insurance Coverage

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  1. The General Assembly finds and declares that:
    1. Maternal and infant health are greatly improved when women have access to contraceptive supplies to prevent unintended pregnancies;
    2. Because many Americans hope to complete their families with two or three children, many women spend the majority of their reproductive lives trying to prevent pregnancy;
    3. Research has shown that 49 percent of all large group insurance plans do not routinely provide coverage for contraceptive drugs and devices. While virtually all health care plans cover prescription drugs generally, the absence of prescription contraceptive coverage is largely responsible for the fact that women spend 68 percent more in out-of-pocket expenses for health care than men; and
    4. Requiring insurance coverage for prescription drugs and devices for contraception is in the public interest in improving the health of mothers, children, and families and in providing for health insurance coverage which is fairer and more equitable.
  2. As used in this Code section, the term:
    1. "Health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, or renewed in this state, including those contracts executed by the state on behalf of state employees under Article 1 of Chapter 18 of Title 45, by a health care corporation, health maintenance organization, preferred provider organization, accident and sickness insurer, fraternal benefit society, provider sponsored health care corporation, or other insurer or similar entity.
    2. "Insurer" means an accident and sickness insurer, fraternal benefit society, health care corporation, health maintenance organization, or any similar entity authorized to issue contracts under this title.
  3. Every health benefit policy that is delivered, issued, executed, or renewed in this state or approved for issuance or renewal in this state by the Commissioner which provides coverage for prescription drugs on an outpatient basis shall provide coverage for any prescribed drug or device approved by the United States Food and Drug Administration for use as a contraceptive. This Code section shall not apply to limited benefit policies described in paragraph (4) of subsection (e) of Code Section 33-30-12. Likewise, nothing contained in this Code section shall be construed to require any insurance company to provide coverage for abortion.
  4. No insurer shall impose upon any person receiving prescription contraceptive benefits pursuant to this Code section any:
    1. Copayment, coinsurance payment, or fee that is not equally imposed upon all individuals in the same benefit category, class, coinsurance level or copayment level, receiving benefits for prescription drugs; or
    2. Reduction in allowable reimbursement for prescription drug benefits.
  5. This Code section shall not be construed to:
    1. Require coverage for prescription coverage benefits in any contract, policy, or plan that does not otherwise provide coverage for prescription drugs; or
    2. Preclude the use of closed formularies; provided, however, that such formularies shall include oral, implant, and injectable contraceptive drugs, intrauterine devices, and prescription barrier methods.

(Code 1981, §33-24-59.6, enacted by Ga. L. 1999, p. 317, § 1; Ga. L. 2019, p. 386, § 68/SB 133.)

The 2019 amendment, effective July 1, 2019, substituted "the state" for "the State of Georgia" in the middle of paragraph (b)(1); deleted "hospital service corporation, medical service corporation," following "fraternal benefit society," in paragraphs (b)(1) and (b)(2); and deleted "on or after July 1, 1999," following "by the Commissioner" near the middle of the first sentence of subsection (c).

Cross references.

- Family planning services, T. 49, C. 7.

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 1999, this Code section, originally designated as Code Section 33-24-59.1, was redesignated as Code Section 33-24-59.6, "of the Official Code of Georgia Annotated" was deleted from paragraph (b)(1), "Code section" was substituted for "Act" in subsection (c), and in subsection (e), "or" was inserted at the end of paragraph (e)(1) and "; provided," was substituted for ", provided," in paragraph (e)(2).

Law reviews.

- For note on 1999 enactment of this Code section, see 16 Ga. St. U.L. Rev. 146 (1999). For note, "Let Your Conscience Be Your Guide: Comparing and Contrasting Washington's Death with Dignity Act and Pharmacy Regulations After the Ninth Circuit's Decision in Stormans, Inc. v. Wiesman," see 52 Ga. L. Rev. 613 (2018).


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