Earlier this year, a law was passed requiring that all Colorado health insurance policies must include maternity coverage as of January 1, 2011. I realized yesterday that I really don’t know much about the exact specifics of how this legislation will be implemented, so I decided to try to find out more. This morning, I called the Colorado Division of Insurance, Governor Ritter’s office, Humana, Aetna, and Anthem Blue Cross Blue Shield. Apparently, I’m not the only one who doesn’t know much about the specifics of HB1021. No one I spoke to had any additional information. The health insurance companies said they had no information about how the bill was going to be implemented yet. The Governor’s office told me that they can’t give out information about interpreting legislation, and the Division of Insurance just read through the bill with me over the phone.
The text of the bill is relatively clear on some of the specifics: It states that all group and individual health insurance policies…
“…shall insure against the expense of normal pregnancy and childbirth or provide coverage for maternity care therefor and provide coverage for contraception in the same manner as any other sickness, injury, disease, or condition is otherwise covered under the policy or contract.”
I would take that to mean that the policy out-of-pocket costs in terms of deductible, coinsurance, hospital and doctor copays, etc. would have to be met by the patient, and the rest of the costs would be covered by the insurance carrier.
The bill also states that individual policies (but not group policies) are still allowed to exclude pregnancy as a pre-existing condition:
“Individual sickness and accident insurance policies or contracts may exclude coverage for pregnancy and delivery expenses on the grounds that pregnancy was a preexisting condition. The exclusion for the pregnancy as a preexisting condition under the policy or contract shall not apply for any subsequent pregnancies.”
But does that mean that the insurance carriers have to accept pregnant women and just exclude the pregnancy and delivery from the coverage? Currently, no individual health insurance carrier in Colorado (or most other states) will accept any expectant parent (mother or father) at all until after the baby is born. The pregnancy is considered a pre-existing condition, and because new babies can be added to either parent’s existing policy in the month following birth with no underwriting, health insurance carriers have all opted to deem pregnancy as an automatic decline. As of 2014, this will no longer be the case, but I have heard nothing indicating that there will be any changes to the universal underwriting guideline that states that an expectant parent cannot get a new individual health insurance policy.
In terms of what policies will be affected, the bill states that the new requirements wills apply to policies “issued or renewed on or after the effective date of this act.” (January 1, 2011). My interpretation of that would be that new policies issued beginning January 1, 2011 will include maternity coverage, and that as existing policies renew throughout the year, maternity will be added to them. So for example, the policy that Jay and I have for our family renews each year on November 1. So I would assume that for the first 10 months of 2011 we will continue to not have maternity coverage, but then as of our renewal date in 2011, maternity will be added to our plan.
Of course my guesses in terms of how this will all work are just that – guesses. And I have not been able to find anyone who has more concrete details at this point. We still have several months left in 2009 for regulators and insurance companies to work out the details, and I’m sure we’ll know more by the end of the year. When you combine this with the new Colorado law banning gender rating on health insurance policies, and the myriad of reforms coming from the federal government, I’d say that health insurance regulators in Denver are going to have their hands full for a while.