Last week I received the an email from a gentleman that was perturbed that his health insurance rates would be increasing because of California’s new mandated coverage for maternity and autism coverage.
Message: Kevin, I just found out from Aetna about my rates going up on October for CA state mandate for Maternity and Autism!!!??? So I will be forced to pay something in my policy which doesn’t relate to my personal health what-so-ever????
Do we have any recourse – other than moving out of California???
A new law for what?
Often times the rational for certain legislative action is not readily apparent to the casual observer. (I admit that I fall into the casual observer category frequently). This gentleman’s email prompted me to attempt to articulate part of the logic behind maternity coverage and how it might play out in different health insurance policies. There is no doubt that the rates will be increasing, not immediately for some companies, as health insurance companies factor in paying claims for maternity services.
My first response:
All plans must include maternity coverage in California. All that means is that once a woman
meets her deductible, the health insurance plan will then share the cost of medical services associated with the delivery or cover all the remaining services, depending on the plan.
It isn’t too different if she had prostate cancer1. She would have to meet the deductible first.
The California law just makes maternity a covered service like fixing a broken leg or having gall bladder surgery. Most small group and large employee group insurance have covered maternity for years. For better or worse, new health care provisions will also cover the cost of a colonoscopy for you at no charge when you turn 50. (ACA healthcare reform provision)
His follow-up question:
I am confused why I, as an adult male, would be responsible for maternity coverage. My plan is an individual plan, yet I am responsible for paying more to cover overall costs of anyone else in California???
My second response:
Up until 2 years ago, health insurers could, and did, charge more for individual policies issued to
women than for men. Although, when you looked at the rates, men actually became more expensive to insure after age of about 50.
Part of that was because women were past their child bearing years and men have more medical issues later in life because we never go to the doctor when we are younger.
Even today, if a woman applies for health insurance, and there might be a hint that she is pregnant, misses or late period, she will be denied for a pre-existing condition: pregnant. That is to avoid adverse selection; only buying insurance when you are ill.
One of the rationales for covering maternity is to get women in for pre-natal visits. If the doctor can catch a complication early, they save the family and health insurance company from expensive procedures later.
Even if there is no maternity coverage, but the mother has insurance, any medical intervention to save the mother’s life during pregnancy would be covered.
The other issue I see is saving public dollars. If a woman can get insurance, and it may or may not actually pay any claims associated with the pregnancy, it may reduce women from turning to publicly subsidized plans. In turn, one would hope, ease the tax payer cost on those programs.
If only men could become pregnant
Later, I wondered, if men could become pregnant would maternity coverage have been included as
a covered benefit years ago? While that may sound like a flippant question, I think it is valid. It is not necessarily a harsh indictment of any insurance product or service that the designer of the product would craft it from his or her own perspective. There are many examples of products that were originally design for historically gender specific use that have been redesigned to be more inclusive.
Supporting your sons and grandsons
In the big picture, men can benefit just as much from maternity coverage as women. After all, it takes a man and a woman to conceive a baby. This is really pro-family legislation. It is on par with paying taxes to support public education even though your children have left the school system. Our communities are sustained and strengthen when public education is available to all. Similarly, families and communities will be strengthened with health insurance that covers one of the most important aspects of family: supporting the delivery of babies and their mothers.
1. I had a comment that technically women don’t have prostates that function the same way as men have. They had been called Skene’s gland up until about 10 years ago. The issue I was trying to address in the email was that it is unwise to exclude medical conditions that are specific to gender. In such a manner, because women do not have testes, perhaps testicular cancer should be excluded from coverage in a health insurance policy. I welcome all comments, clarification and corrections.