Of the people in reproductive years (ages 15-44) who report high out-of-pocket health care expenses, over two-thirds are women. More than ten percent of their income is spent on health care. Five million of these women have private insurance. ²

Costs of contraception add up. In 1993, the total cost of Norplant insertion was approximately $700, the total cost of IUD insertion was $400, and a year's supply of oral contraceptives with the necessary medical exam cost about $300. ³

Private Insurance Plans Unfairly Exclude Contraceptive Coverage
Women do not receive equal coverage or equal care. Forty-nine percent of the insurance plans that are defined as preferred provider organizations (PPO) or fee-for-service (indemnity) do not routinely cover standard contraceptive methods. Almost half of all privately insured Americans have these plans.⁴

Health maintenance organizations (HMO), which cover one-third of the population, largely fail to cover all of the five leading contraceptive methods.⁵

But, nearly all insurance plans cover prescriptions in general. The plans simply exempt prescriptions for birth control drugs and devices.⁶

Government Employees May Not Have Coverage for the Full Range of Contraception
In many state plans, administrators select the benefits offered to government workers and do not always include comprehensive contraceptive care. The benefits for some state and municipal employees are established in collective bargaining agreements or by statutes or regulations, all of which may limit or exclude contraception.

At the federal level, government employees (excluding those in the military) are eligible to receive health insurance under the Federal Employees Health Benefits Act (FEHBA).⁷ FEHBA is an existing statutory plan, but as part of the 1998 federal budget agreement, a new provision took effect requiring contraceptive coverage in health plans offered to government employees if other prescriptions are covered.⁸ But the requirement for contraceptive coverage must be reapproved every year. In addition, health care plans that claim to have religious objections to contraceptive coverage need not provide it and are exempted from the law.

Members of the military, covered under CHAMPUS,⁹ do not have coverage for all of the contraceptive drugs and devices approved by the FDA. Among those excluded are Norplant, cervical caps and Depo Provera.

Good Private Insurance Protection for Women's Contraceptive Services Should:

• Provide coverage for all of the FDA-approved contraceptive drugs and devices and allow purchase of them at pharmacies, health clinics and doctor's offices, or by mail order.
• Cover annual office visits with an obstetrician or gynecologist. These should include contraceptive counseling and care, counseling on sexually transmitted infections, and pap smears.
• Require only copayments, deductibles, and caps on benefits for contraceptive care that are the same as (or better than) those for other medical services.
• Protect individual and family confidentiality in its processing of claims by ensuring that the policy holder, spouse and dependents can obtain contraceptive care without notice to employers or, in the case of a spouse or dependent, without notice to the policy holder.
• Allow the policy holder, if in a managed care plan, to select an obstetrician or gynecologist as a primary care physician, or let the policy holder obtain family planning services from the provider of choice without the prior approval of a gatekeeper.

• Oral contraceptives (birth control pill)
• Injectable contraception (Depo Provera)
• Contraceptive implants (Norplant)
• Diaphragms
• Intrauterine devices (IUDs)
• Cervical caps
• Emergency Contraception