December 7th, 2010 – Colorado’s Division of Insurance just issued clarification on the upcoming changes for maternity coverage that will effect individual health insurance plans in Colorado starting on January 1st, 2011.
The DOI clarified that the clear intent of the General Assembly was to expand coverage only to policies issued (and not renewed) on or after January 1, 2011.
In lay terms, individual health insurance policies issued prior to January 1st, 2011 are NOT required to provide maternity coverage for normal pregnancies. It is also worth noting that the law still allows insurance companies to exclude pregnancy as a pre-existing condition on individual policies, so it is important to get a NEW individual health insurance policy AFTER January 1st, 2011 and BEFORE one becomes pregnant.
After January 1st, 2011 new individual health insurance policies are supposed to cover pregnancy and delivery like a sickness, injury or disease. Obviously, pregnancy is not a sickness or disease, but what they mean is that pregnancy and delivery will be subject to the policy’s copays, deductibles and coinsurance.
For those interested in reading the specifics of the law, Section 10-16-104(3), C.R.S., was amended on May 26, 2010 by HB 10-1021 to expand Colorado’s mandatory maternity coverage to individual health insurance policies. This had previously been limited just to employer sponsored group health insurance policies.
The law reads, that effective January 1st, 2011,
“All group sickness and accident insurance policies providing coverage within the state and issued to an employer by an entity subject to part 2 of this article, all group health service contracts issued by an entity subject to part 3 or 4 of this article and issued to an employer, all individual sickness and accident insurance policies issued by an entity subject to part 2 of this article, and all individual health care or indemnity contracts issued by an entity subject to part 3 or 4 of this article, except supplemental policies covering a specified disease or other limited benefit, shall insure against the expense of normal pregnancy and childbirth or provide coverage for maternity care 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. 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. Group sickness and accident insurance policies or contracts shall not exclude coverage for pregnancy and delivery expenses on the grounds that pregnancy was a preexisting condition.”