States mandating infertility insurance coverage
The law may say that the mandate only applies to large group plans, for example, or that it doesn’t apply to any plans that are required to provide the essential health benefits. “Your state has passed a law but everything is so market specific it’s hard to know what coverage you’re getting,” says Katie Keith, research director at the Trimpa Group, a consultant for autism and other advocacy groups.
A state may say that if the mandate increases premiums by a certain percentage the provision doesn’t apply. Although some states are trying to sidestep having to pay for new mandates by limiting which plans are included, advocates say uncertainty about who is going to have to foot the bill is having a chilling effect overall.
Since the health law established a comprehensive set of “essential health benefits” that individual and small group plans must cover (unless they existed prior to passage of the law in 2010), it was hoped that mandates would no longer be much in demand, says Sabrina Corlette, project director at Georgetown University’s Center On Health Insurance Reforms.
Mandates are “not the most rational way to build a benefit package,” says Corlette.
To discourage states from passing mandates that go beyond essential health benefits requirements, the law requires states, not insurers, to cover the cost of mandates passed after 2011 that apply to individual and small group plans sold on or off the state health insurance marketplaces.
If a mandate increases a plan’s premium, states will be on the hook for the additional premium cost that’s attributable to the mandate.
States have taken different approaches to structuring new mandates so they don’t have to pay for them, says Justin Giovannelli, a research fellow at Georgetown’s Center on Health Insurance Reforms, who has examined state laws in this area.But the mandates have also increased multiple birth rates in these states, and those births can be costly and risky," Buckles said.Currently, the seven states with strong mandate-to-cover laws are Maryland, Arkansas, Hawaii, Massachusetts, Rhode Island, Illinois and New Jersey.That figure likely is an underestimate of the total costs induced by the mandates, since it does not include costs associated with triplet pregnancies, with treating the immediate and later-life complications associated with triplet births or costs from quadruplet and higher-order births, according to Buckles, who specializes in family and health economics.
"These mandates have benefited many women by helping offset the huge costs of infertility treatments.
For decades, states have set rules for health coverage through mandates, laws that require insurers to cover specific types of medical care or services.