The california health benefits exchange: helping californians access quality and affordable health coverage
CALIFORNIA COVERAGE NOW INCLUDES MATERNITY CARE FOR INDIVIDUAL & SMALL GROUP HEALTH PLANS
As of July 1, 2012, California requires that all health insurance plans, including in the individual and
small group markets, include maternity service as a covered benefit. This key consumer protection will
help new mothers get the maternity coverage they need, which will provide a healthier start to their
children, financial security for their families, savings for taxpayers, equity for women, and benefits for
society into the future.
THE NEED FOR NEW RULES ON MATERNITY
While maternity care is obviously vital to life, in the past few years, insurers have relegated maternity
coverage to a rarely-offered benefit. While large group health insurance plans and health maintenance
organizations (HMOs) include maternity coverage, private individual plans and small group plans
increasingly did not, and prior to July 2012, they were not required to provide coverage for maternity-
related expenses. In 2004, 82% of plans included maternity coverage while in 2010, only 12% did. In
some parts of the state, it is less than 1%. When women can get By contrast, at least 50% of health
plans cover Viagra and other erectile dysfunction remedies, a stark gender inequality. SAVING CONSUMERS MONEY
Several studies show that the lack of access to pregnancy related services can have detrimental effects
on the health of mothers and children.
As a result, the state of California allows pregnant women to be covered under Medi-Cal or Access for Infants and Mothers (AIM). When insurers fail to recognize maternity care as an essential health benefit, Medi-Cal, and California taxpayers are then left picking up the tab. In 2006, 41.3%, or 232,241 births to resident Californians were paid by the Medi-Cal program. This number has inevitably grown as fewer and fewer insurers offer this benefit. By providing prenatal care to more women, it will reduce the incidence of premature births which cost an estimated $2 billion dollars each year for Californians.
ASSURING QUALITY COVERAGE
The effort to pass the maternity coverage requirements was over eight years, five bills, four authors,
and three Governors. The Affordable Care Act signed into law by President Obama in March 2010 will
define a set of minimum essential benefits that must be covered by all insurance plans by 2014,
including maternity care. Two bills passed by the California Legislature and signed by Governor Brown
in 2011, AB210 (Hernandez) and SB222 (Evans/Alquist) implements a maternity care mandate 18
months earlier, no later than July 1, 2012, which provides a transition to implementing the full ACA.
The coverage for maternity services will include:
• Involuntary complications of pregnancy
• Inpatient hospital maternity care which include labor and delivery and postpartum care
This law will bring maternity coverage to thousands of women who do not have it now. Every child born in California deserves a safe and healthy start to life.
For more info, contact Health Access (916) 497-0923 or www.health-access.org
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