California Mandatory Maternity Benefits SB 222

Effective July 1, 2012, all individual & family health insurance plans in California must provide maternity coverage to subscribers.

The Bill, SB 222, was passed into law in late 2011 and requires all individual & family health insurance plans in California to include coverage for maternity including prenatal and postnatal. This includes plans registered with both the CA Dept of Managed Health Care (DMHC) and the CA Dept of Insurance (CDI). The law, signed by Gov Brown in 2011, estimates an average cost increase (premium) of about $7 per month per subscriber.

As of this date none of the California health insurance carriers selling individual & family coverage have announced how they intend to implement the new benefits. I expect most if not all carriers will simply add the benefit to existing plans without creating a new series of "open" plans to accommodate the new benefit.

This benefit additiona affects all individual & family health plans. Anyone currently on a non-maternity coverage plan in California will have the benefit added on July 1, 2012.

CA SB 222

Dave
Find me here

Comments

  1. Because of this rediculous legislation, my insurance plan just raised our rates by $118/month. They said even a 5 year old boy has to have maternity in his insurance plan. This is lining the pockets of the insurance companies and Gov. Jerry Brown should go to jail over this it is so scandalus and bizzare. Where is the logic in this? So the insurance companies can charge for maternity to clients that have no maternity liability.

    ReplyDelete
  2. The flip side of that is that now they just charge women who want the coverage 3 or 4 times the amount of a policy without maternity coverage.

    ReplyDelete
  3. do you happen to know when the companies are announcing what the coverage will be or will it just randomly show up on our benefits come july 1st?

    ReplyDelete
  4. No one knows yet. I do know Anthem Blue Cross will simply add the benefit onto the existing portfolio of plans that currently do not offer maternity benefits. I would assume other carriers will follow suit.

    Aetna is the wildcard right now because they exited Colorado last year due to mandatory maternity benefits and we are waiting to see whether they will add them on in CA. I expect the market in CA may be so large that a carrier won't want to drop out but we have to wait and see.

    ReplyDelete
  5. Hi David

    Thanks for this update - I have Anthem Blue Cross regular individual insurance and I 'suspect' I might be pregnant. If Anthem Blue Cross will add this benefit to my insurance on 1st July, do you think the benefits be applicable to a pregnancy which was conceived before 1st July?

    ReplyDelete
    Replies
    1. It's not clear yet but I would expect that they will apply a 6-month pre-ex rule to anyone who is pregnant before the maternity benefit is added. I would also expect that they will waive the waiting period for those who have 6 or more months of prior creditable coverage. I will add a new blog post once I get actual information on the exact process.

      Delete
  6. I think it is also essential to explain to future moms and dads why maternity insurance is so important. Costs can be huge for pregnancy and a policy has to be bought early because of the waiting period. Useful blog concerning these issues is at http://www.healthinsurancewithmaternitycoverageblog.com.

    ReplyDelete
  7. Just received my letter from Anthem Blue cross regarding maternity coverage mandatory starting July 1, 2012. I just switched plans last year to get a plan without maternity, now I a 61 year old female who cannot have children anymore HAVE to have this coverage along with ANY males! This is a ridiculous law and stunned that I never read or heard about it. I agree it must be putting money in someones pockets or making me help pay for someone else's babies!! How can this be changed? Is there anything we can do to get this stopped?

    ReplyDelete
  8. I also changed my policy last year as I was paying for maternity coverage that I would never use. When I first heard of the new law I had a similar negative reaction, however I believe there is some logic to it.

    Anyone with health insurance is already paying for all kinds of coverage that they will either never use, or are very unlikely to ever need. This is required in order to make the whole system work. If we only paid for what we actually needed it would not be sustainable. You could argue that since some people are guaranteed to never need maternity coverage it's different than being covered for something that is just highly unlikely, however I think the principle is similar. There are many genetic factors and lifestyle choices that clearly increase or decrease the need for certain coverage that we cannot simply opt out of. Plus many pregnancies are unplanned or unexpected, so that's a whole other category aside from the males or seniors etc. that muddies the water here.

    Further, by making maternity coverage more affordable and available, there is a potential for long term savings due to the additional preventative care. The expense to the system of caring for uninsured infants with preventable complications and birth defects is enormous (and can last a life time). Similarly, we already pay property tax which supports school children regardless of our age, gender or if we'll ever have kids enrolled in the schools, and both a healthy and educated society benefits everyone.

    This should be part of a more comprehensive reform so that even though some changes like this will increase premium costs for some, other changes should offset that in the longer term. Of course making comprehensive reform is no small task, and few provisions if any would be supported by everyone. So as it stands we'll get incremental changes that we may or may not agree with.

    Frankly I have much less of a problem kicking in for maternity coverage I'll never use vs subsidizing high-health-cost lifestyle choices I don't participate in such as smoking, eating unhealthy food and being a couch potato, to name a few.

    ReplyDelete
  9. Hi Dave,
    I live in CA and Maternity benefits were added to my Aetna plan, however there are major exclusions, including routine prenatal ultrasounds, as well as high deductibles for going out of network. Do you know if SB222 details exact requirements of insurance companies? Have there been any lawsuits for companies not abiding by SB222?

    ReplyDelete
  10. In the article there is a link at the bottom to SB 222, you can click the link and read the entire bill and see if it addresses specifics.

    Going out of network is never a good idea and Aetna really penalizes for that, more than either Blue Cross (Anthem) or Blue Shield.

    ReplyDelete

Post a Comment

Popular Posts