Maternity Coverage On Renewing Individual Policies

Since January 1, 2011, all new individual health insurance policies issued in Colorado have included maternity coverage as required by a new state law.  The text of the bill was quite clear in stating that its provisions would apply to all “policies issued or renewed on or after the applicable effective date of this act.” (see the top of page 3 of the text).  But until now, there was still some confusion around maternity coverage and policy renewals, and inconsistencies in how the law was being applied.

The Colorado Division of Insurance issued a press release yesterday clarifying the situation and describing possible retroactive premium increases for some insureds whose policies have already renewed this year.  To sum things up, the Division of Insurance had issued a bulletin in December stating that all new individual policies issued as of January 1, 2011 would have to include maternity coverage, but that this did not apply to renewing policies.  Some carriers went ahead and added maternity coverage to renewing policies anyway, but some did not.  The Division of Insurance has since reviewed the data again and has determined that in order to comply with the law, all new and renewing individual policies must include maternity coverage.

So if you purchase a new individual health insurance policy in Colorado starting this year, it will include maternity coverage.  And if you already had an individual policy as of January 1, maternity coverage will be included in your benefits as of your 2011 policy renewal date (for example, our family’s policy renews each year on November 1.  So we do not currently have maternity coverage, but it will be added to our policy as of November 1 this year).  Pregnancy is still considered a pre-existing condition, so if you’re pregnant at the time your policy renews, the pregnancy will not be covered.

The Division of Insurance press release also addresses the issue of retroactive premium increases that may impact some insureds in the state.  For people who have a policy that has already renewed this year, and is provided by a carrier that had previously opted to not include maternity coverage for renewing policies (per the Division of Insurance bulletin from December 2010), premiums may have to be adjusted upwards to reflect the inclusion of maternity coverage starting on the renewal date.  This could result in additional premiums being due for the time since the policy renewed, and higher premiums going forward.  Carriers that did not file renewal rates with the Division of Insurance to include maternity coverage will have to do so now – and the rates will have to be approved – before insureds can be charged the additional premiums.

 

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.

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