Insurers violate ACA's women's health coverage requirements, reports say
Many health insurers violate the Affordable Care Act's women's health coverage requirements, according to a recent report from the National Women's Law Center (NWLC).
The NWLC examined coverage for health plans in 15 states in 2014 and 2015 and found that 14 health plans across seven states offer maternity coverage that does not comply with ACA requirements. For instance, the plans exclude maternity coverage for dependent enrollees, restrict pregnant women's access to maternity services outside of the plan's network and establish limits on maternity benefits.
The report also found that 56 plans across 13 states impose cost-sharing on women's preventive services, limit the frequency of well-woman visits and fail to cover all birth control methods.
When it comes to covering birth control methods, a second report from the NWLC found that various plans fail to cover the 20 Food and Drug Administration (FDA)-approved birth control methods without out-of-pocket costs. For instance, a plan in South Dakota does not cover the contraceptive implantable rod, while 10 plans in Maine, Minnesota, Ohio, Rhode Island and Wisconsin exclude all over-the-counter contraceptive methods.
Under the ACA, health plans must cover all FDA-approved contraceptives without cost-sharing, FierceHealthPayer previously reported. However, not all plans follow this provision. Two plans in Nevada impose cost-sharing on all women's preventive services which ultimately could deter women from obtaining important benefits, noted the first report. Additionally, seven plans in six states require cost-sharing for services associated with birth control.
Both NWLC reports provide guidance for insurers and plans to improve their coverage options and thus comply with the ACA. Health plans must have clear coverage policies that identify what is covered within their plans and make these documents available, the NWLC noted. What's more, insurers need to examine their plans to ensure they cover all FDA-approved contraceptive methods without cost-sharing.
For more:
- here are the first and second reports (.pdf)
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