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Few Individual Health Policies Cover Maternity

October 15, 2008
San Francisco Chronicle
The number of individual health insurance policies that do not include maternity coverage has risen dramatically in recent years, prompting concern among consumers and a legislative effort to require California insurers to include the benefit.
About 805,000 Californians have insurance policies that specifically exclude maternity coverage - a number that has more than quadrupled from 192,000 in 2004, according to the California Health Benefits Review Program, which provides independent analysis of proposed health insurance benefits mandates.
"You see this tremendous jump in just a few years. That's where we're going with this," said Assemblyman Hector De La Torre, D-South Gate (Los Angeles County), whose bill to require maternity coverage is headed to the Assembly Health Committee today. Insurance companies are "pushing these policies clearly onto people, and people are making their decisions based solely on dollars and cents."
As more people lose their jobs - and along with that, their health insurance benefits - an increasing number are expected to turn to the individual health insurance market for coverage, an option that is usually less expensive than paying to stay on their former employers' health plans.
De La Torre's bill, AB98, would require all health insurance products regulated by the state Department of Insurance to include maternity benefits. Gov. Arnold Schwarzenegger vetoed a similar bill authored by De La Torre last year as well as one introduced in 2004 by then-Sen. Jackie Speier, D-Hillsborough.
Health insurers and consumers who support the right to buy a policy that excludes maternity benefits say they shouldn't have to pay for a service they have no intention of using. They say requiring such coverage would increase premiums and force more people to go without insurance.
"Clearly there are a number of people out there who don't think they need or want a maternity benefit at this point in their lives and recognize there is a significant reduction in costs associated with this," said Ben Singer, spokesman for Anthem Blue Cross, which covers about half of the individual policyholders in the state who do not have maternity coverage. Singer said requiring the benefit could increase premiums by as much as 107 percent for some members.
Shared risk
Supporters of the mandate, however, argue that denying coverage is unfair to women and that, in exchange for an average $7.17, or 4.24 percent, increase in monthly premium price per individual policyholder, society would save money if fewer women were on government-supported programs.
De La Torre argued that excluding maternity flies in the face of the insurance philosophy of shared risk. "Why do women pay for prostate cancer? Why do men pay for breast cancer? Because that's the whole point of insurance," he said.
The controversy is limited to individual insurance coverage because group policies, those provided by an employer or group, include maternity benefits. Health maintenance organizations, or HMO plans, are required by the state to have maternity coverage, but preferred provider organization, or PPO, service plans are free to exclude the benefit.
People who buy individual plans typically do not have access to group coverage. They can be self-employed, work for an employer that does not provide health insurance or simply choose such policies as the most affordable options.
But with the growing popularity of such policies without maternity coverage - such as Anthem Blue Cross' low-cost Tonik plans, which are geared toward young adults - finding an affordable individual plan with the coverage can prove to be a daunting task.
No good options
When Wendy Root Askew of Monterey started looking for a doctor she hoped would be her gynecologist as well as deliver her future children, she was shocked to discover her health insurance policy didn't include a single OB/GYN in her county.
The 31-year-old considered changing health plans. But then she learned that while 85 percent of the plans available in Monterey County offered maternity coverage five years ago, just 15 percent offer it now.
She found only two individual policies that included maternity, but they were three to five times as much as the policy she already had and came with annual deductibles of up to $15,000.
"Who's going to be buying policy with a $10,000 or $15,000 deductible? Clearly only those women who are intending to use the service," said Askew, who went from running her own business to working for an employer that offers group health insurance. She said she made the decision in part because the job offered comprehensive health benefits.
Health insurers are not uniformly against mandating maternity benefits. Kaiser Permanente, which as an HMO is required to include maternity, has supported maternity mandates along with Blue Shield of California, which has come out in favor of De La Torre's bill. The California Association of Health Plans has not taken a position, while another insurance trade group, the Association of California Life & Health Insurance Companies, publicly opposes the bill.
Higher individual rates
Several states, including Massachusetts, New Jersey and New York, already have laws in place requiring plans to pay for maternity services.
Anthem Blue Cross' Singer said that those states have much higher rates for individual insurance coverage than California.
"The point of insurance is to insure against catastrophic care costs. That's what you're trying to aggregate and pool for such things as heart attacks and cancer," he said. "Having a child is a matter of choice. Dealing with an adult onset illness, such as diabetes, heart disease breast or prostate cancer, is not a matter of choice."
Patricia Bellasalma, president of the California National Organization for Women, noted that not all pregnancies are planned. She said some insurance companies are discriminating against women.
"The philosophy of the insurance company on maternity coverage - the only pool of risk takers are women - is that all of the obligations to pay for child bearing is born solely on the woman and not on the man and not on society, which is just outrageous," she said.
Women in California pay an estimated 39 percent more than men for coverage in the individual market. San Francisco City Attorney Dennis Herrera filed a lawsuit against the state in January over the issue. Legislation also has been introduced by state Sen. Mark Leno, D-San Francisco, and Assemblyman Dave Jones, D-Sacramento, to forbid gender rating.
E-mail Victoria Colliver at [email protected].
This article appeared on page A - 1 of the San Francisco Chronicle
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