S.F. 188 Section 1. NEW SECTION . 514C.19A Contraceptive drugs, 1 devices, and services. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Contraceptive device” means any device or non-drug 5 product that has been approved as a contraceptive by the United 6 States food and drug administration. 7 b. “Contraceptive drug” means any drug approved 8 as a contraceptive by the United States food and drug 9 administration. 10 c. “Medical need” means considerations such as severity of 11 side effects, difference in permanence and reversibility of 12 a contraceptive drug or contraceptive device, or an ability 13 to adhere to the appropriate use of such drug or device, as 14 determined by a health care professional. 15 d. “Therapeutically equivalent version” means a drug or 16 device that has the same clinical effect and safety profile 17 as another drug or device and that meets the criteria for 18 therapeutic equivalence as determined by the United States food 19 and drug administration. 20 2. Notwithstanding the uniformity of treatment requirements 21 of section 514C.6, a policy, contract, or plan providing 22 for third-party payment or prepayment of health or medical 23 expenses, and that provides coverage for prescription drugs, 24 shall not do any of the following: 25 a. Exclude or restrict benefits for contraceptive 26 drugs, contraceptive devices, or generic equivalents 27 approved as substitutable by the United States food and drug 28 administration, if such policy, contract, or plan provides 29 benefits for other noncontraceptive prescription drugs or 30 devices. 31 b. Exclude or restrict benefits for outpatient contraceptive 32 services which are provided for the purpose of preventing 33 conception if such policy, contract, or plan provides benefits 34 for other outpatient services provided by a health care 35 -1- LSB 1188XS (7) 91 nls/ko 1/ 6

S.F. 188 professional. 1 c. Deny to an individual eligibility, or continued 2 eligibility, to enroll in or to renew coverage under the terms 3 of the policy, contract, or plan because of the individual’s 4 use or potential use of contraceptive drugs, contraceptive 5 devices, or outpatient contraceptive services. 6 d. Provide a monetary payment or rebate to a covered 7 individual to encourage such individual to accept less than the 8 minimum benefits provided under this section. 9 e. Penalize or otherwise reduce or limit the reimbursement 10 to a health care professional because such professional 11 prescribes contraceptive drugs, contraceptive devices, or 12 provides contraceptive services. 13 f. Provide incentives, monetary or otherwise, to a health 14 care professional to induce such professional to withhold 15 from a covered individual contraceptive drugs, contraceptive 16 devices, or contraceptive services. 17 g. Impose upon any covered individual receiving benefits 18 pursuant to this section any deductible, coinsurance, or 19 copayment for benefits for contraceptive drugs, contraceptive 20 devices, or contraceptive services. 21 3. Notwithstanding subsection 2, paragraph “g” , a policy, 22 contract, or plan that provides coverage for more than one 23 therapeutically equivalent version of a contraceptive drug 24 or contraceptive device may impose cost-sharing on any 25 therapeutically equivalent version, provided that at least one 26 therapeutically equivalent version of the contraceptive drug 27 or contraceptive device is available without cost-sharing. 28 However, if a covered individual’s health care professional 29 recommends a particular contraceptive drug or contraceptive 30 device based on a determination of medical need, coverage 31 shall be provided for the recommended contraceptive drug or 32 contraceptive device without cost-sharing. 33 4. This section shall not be construed to do any of the 34 following: 35 -2- LSB 1188XS (7) 91 nls/ko 2/ 6

S.F. 188 a. Limit or otherwise discourage the use of generic 1 equivalent drugs approved by the United States food and drug 2 administration, whenever available and appropriate. 3 b. Prohibit a third-party payor from requiring a covered 4 individual to pay a deductible, coinsurance, or copayment 5 consistent with this section, in addition to the difference of 6 the cost of a brand-name drug less the maximum covered amount 7 for a generic equivalent, when a brand-name drug is requested 8 by a covered individual and a suitable generic equivalent is 9 available and appropriate. 10 c. Require a third-party payor under a policy, contract, or 11 plan to provide coverage for an experimental or investigational 12 contraceptive drug or contraceptive device, or an experimental 13 or investigational contraceptive service, except to the extent 14 that such policy, contract, or plan provides coverage for other 15 experimental or investigational outpatient prescription drugs 16 or devices, or experimental or investigational outpatient 17 health care services. 18 5. A policy, contract, or plan to which this section 19 applies shall not impose any burdensome restrictions or delays 20 on the coverage required by this section and shall provide 21 clear, written, and complete information on its internet site, 22 and by mail at the request of a current or potential covered 23 individual, about the contraceptive coverage included and 24 excluded from the plans offered by the policy, contract, or 25 plan. 26 6. A policy, contract, or plan to which this section applies 27 shall include a coverage provision that satisfies subsections 2 28 through 5, and shall provide that the policyholder may reject 29 the coverage provision at the option of the policyholder. 30 7. a. This section applies to the following classes of 31 policies, contracts, and plans providing for third-party 32 payment or prepayment of health or medical expenses, and that 33 provide coverage for prescription drugs, provider contracts, 34 policies, or plans delivered, issued for delivery, continued, 35 -3- LSB 1188XS (7) 91 nls/ko 3/ 6

S.F. 188 or renewed in this state on or after January 1, 2026: 1 (1) Individual or group accident and sickness insurance 2 providing coverage on an expense-incurred basis. 3 (2) An individual or group hospital or medical service 4 contract issued pursuant to chapter 509, 514, or 514A. 5 (3) An individual or group health maintenance organization 6 contract regulated under chapter 514B. 7 (4) A plan established for public employees pursuant to 8 chapter 509A. 9 b. This section shall not apply to accident-only, specified 10 disease, short-term hospital or medical, hospital confinement 11 indemnity, credit, dental, vision, Medicare supplement, 12 long-term care, basic hospital and medical-surgical expense 13 coverage as defined by the commissioner of insurance, 14 disability income insurance coverage, coverage issued as a 15 supplement to liability insurance, workers’ compensation or 16 similar insurance, or automobile medical payment insurance. 17 Sec. 2. REPEAL. Section 514C.19, Code 2025, is repealed. 18 EXPLANATION 19 The inclusion of this explanation does not constitute agreement with 20 the explanation’s substance by the members of the general assembly. 21 This bill relates to health insurance coverage for 22 contraceptive devices, drugs, and services. 23 The bill prohibits a policy, contract, or plan providing for 24 third-party payment or prepayment of health or medical expenses 25 (policy), and that provides coverage for prescription drugs, 26 from excluding or restricting benefits for contraceptive drugs, 27 contraceptive devices (contraceptives), or generic equivalents, 28 if the policy provides benefits for other prescription drugs 29 or devices. “Contraceptive device” and “contraceptive drug” 30 are defined in the bill. The bill also prohibits a policy from 31 excluding or restricting benefits for outpatient contraceptive 32 services that are provided for the purpose of preventing 33 conception if the policy provides benefits for other outpatient 34 services provided by a health care professional (professional). 35 -4- LSB 1188XS (7) 91 nls/ko 4/ 6

S.F. 188 A policy is prohibited from denying to an individual 1 eligibility, or continued eligibility, to enroll in or 2 renew coverage under the terms of the policy because of 3 the individual’s use or potential use of contraceptives 4 or outpatient contraceptive services; providing a monetary 5 payment or rebate to a covered individual to encourage such 6 individual to accept less than the minimum benefits provided 7 for under the bill; penalizing, reducing, or limiting the 8 reimbursement to a professional because such professional 9 prescribes contraceptives or provides contraceptive services; 10 and from providing incentives to a professional to induce 11 such professional to withhold from a covered individual 12 contraceptives or contraceptive services. The bill also 13 prohibits a policy from imposing upon any covered individual 14 any deductible, coinsurance, or copayment for benefits for 15 contraceptives or contraceptive services. 16 Under the bill, a policy that provides coverage for more 17 than one therapeutically equivalent version of a contraceptive 18 may impose cost-sharing requirements, provided that at least 19 one therapeutically equivalent version of the contraceptive 20 is available without cost-sharing. If a covered individual’s 21 professional recommends a particular contraceptive based on a 22 determination of medical need, a policy shall provide coverage 23 for the recommended contraceptive without cost-sharing. 24 The bill does not limit or otherwise discourage the use of 25 generic equivalent drugs approved by the United States food 26 and drug administration, whenever available and appropriate. 27 When a brand-name drug is requested by a covered individual and 28 a suitable generic equivalent is available and appropriate, 29 the bill does not prohibit a third-party payor from requiring 30 the covered individual to pay a deductible, coinsurance, 31 or copayment, in addition to the difference of the cost of 32 the brand-name drug less the maximum covered amount for a 33 generic equivalent. The bill does not require a third-party 34 payor under a policy to provide benefits for experimental 35 -5- LSB 1188XS (7) 91 nls/ko 5/ 6

S.F. 188 or investigational contraceptives, or experimental or 1 investigational contraceptive services, except to the extent 2 that such policy provides coverage for other experimental or 3 investigational outpatient prescription drugs or devices, 4 or experimental or investigational outpatient health care 5 services. 6 A policy shall not impose any burdensome restrictions or 7 delays on the coverage required by the bill and shall provide 8 clear, written, and complete information on its internet site, 9 and by mail upon request, about the contraceptive coverage 10 included and excluded from the offered plans. 11 A policy shall include a coverage provision. The policy 12 shall provide that the policyholder may reject the coverage 13 provision at the option of the policyholder. 14 The bill applies to third-party payment provider contracts, 15 policies, or plans delivered, issued for delivery, continued, 16 or renewed in this state, on or after January 1, 2026, by the 17 third-party payment providers enumerated in the bill. The bill 18 specifies the types of specialized health-related insurance not 19 subject to the bill. 20 -6- LSB 1188XS (7) 91 nls/ko 6/ 6