For as long as we have been in the individual health insurance business, being an expectant parent has been a cause for decline with every major individual health insurance carrier in Colorado (and indeed, in most states). Although medical underwriting guidelines change frequently and vary quite a bit from one carrier to another, we have never seen a Colorado carrier that will accept individual applicants who are pregnant at the time they apply. Regardless of whether or not maternity coverage was included in the policy or available as a rider, an existing pregnancy prevents a person from getting a policy at all in the individual market.
In reviewing a new bulletin issued by the Colorado Division of Insurance yesterday, I came across a frequently asked questions page that the DOI released to provide further clarification regarding maternity coverage and Colorado law. The FAQ page clarifies several points that consumers might have, but it also raises one huge question… can an existing pregnancy still be cause for decline in the individual market in Colorado?
The FAQ page states:
“Any NEW individual policy sold on or after January 1, 2011 must include maternity coverage. For anyindividual policy that is RENEWED on or after January 1, 2011, the coverage begins on the first day therenewed coverage is in effect. As of January 1, 2011, any pregnancy for which conception occurred prior to a policy’s issuance date orrenewal date can be treated by the carrier as a preexisting condition and therefore, benefits can bedenied. A person who is already pregnant may obtain insurance at this time, but the current pregnancy would not be covered under this mandate.” (emphasis added)
I have spoken with reps from some of our carriers, and they are unaware of any changes that would require them to offer new policies to pregnant applicants. I have a call in to the Division of Insurance regarding this issue too, and will update this post as soon as I hear back from them.
My understanding of HB 1021 was that it didn’t change anything with regards to medical underwriting. The bill states that pregnancy is still considered a pre-existing condition, which I would interpret to mean that carriers can use whatever underwriting guidelines they already have in place. In the case of an applicant applying for a new policy, the “pre-existing condition” of pregnancy results in a decline, and I see nothing in HB 1021 that would prohibit this action.
The language in the Division of Insurance FAQ page does seem to create some confusion on the issue. Stating that “A person who is already pregnant may obtain insurance at this time” could be interpreted in various ways… some might see it as saying that the person may obtain insurance if the carrier allows it (which none of them currently do), while others might see it as stating that the DOI interpretation of the law requires carriers to treat a current pregnancy as a specific exclusion rather than cause for an outright decline.
I will clarify this issue as soon as I have some more concrete data from the DOI.
UPDATE (3/16/11): I received an email from the DOI with the following information:
If the policy is issued or renewed the carrier must provide for maternity. There is nothing in CRS 10-16-104(3)(a)(I) that requires carriers to guarantee issue policies for applicants who are pregnant.
http://www.dora.state.co.us/insurance/legi/2011/legiCRSonMaternity031111.pdf
This is in agreement with my own understanding of the law. But I pointed out to the DOI that the language in the FAQ bulletin could definitely be confusing to someone looking to purchase individual health insurance. If they end up making any revisions to the bulletin, I will post another update here.
To clarify – regardless of how you might interpret the wording in the FAQ page – a person who is currently pregnant will not be able to obtain a new individual policy in Colorado, as carriers still consider an existing pregnancy to be cause for decline. A person who is pregnant at the time their policy renews will not have coverage for the current pregnancy, but subsequent pregnancies will be covered.
