Pennsylvania: Stop Insurers from Denying Essential Maternity Coverage to Women

Women in Pennsylvania need comprehensive maternity insurance coverage.  While federal and state laws protect access to maternity coverage for many women who receive health insurance through their employers, there is no law ensuring maternity benefits to women in Pennsylvania who purchase an individual policy of insurance.  Individual health insurance policies typically do not cover maternity care, leaving these women at risk of having inadequate or no insurance when they become pregnant.  In addition, women who are pregnant when they apply for insurance often are denied coverage for pregnancy, which is considered a pre-existing condition.  The Affordable Care Act (ACA) may protect these women by 2014 because it requires maternity coverage as part of its essential benefits package.  However the ACA does not define what maternity benefits means. So the U.S. Department of Health and Human Services (HHS) must adopt a broad definition of maternity care to make sure full coverage is provided in 2014.  In the meantime, women need full coverage now

To fill the gap, Pennsylvania State Senator Farnese has introduced the Insuring Motherhood Bill, S.B. 1063, which would (1) ensure that individual and small group health plans provide women with essential maternity coverage and (2) stop insurers from denying maternity coverage to women by classifying pregnancy as a pre-existing condition.

Comprehensive Maternity Coverage is important for the health of women and children.  Early initiation of prenatal care allows the medical provider to diagnose and treat problems with the pregnancy as soon as possible and also gives the provider an opportunity to educate women about behavioral risks, such as smoking.  This type of care is critically important for reducing the maternal mortality rate, reducing the rate of neonatal death, lowering the likelihood of having a baby with low birth weight, and lowering the likelihood of delivering preterm.  Postpartum care is also important for addressing a range of health issues, such as postpartum depression, breastfeeding, bladder/bowel dysfunction, and concerns about sexuality and contraception. 

The Women’s Law Project (WLP) believes that comprehensive maternity coverage is vital to meet the health needs of mothers and babies, and so strives to eliminate sex discrimination in insurance and to expand insurance coverage.  To meet this goal, WLP managing attorney Terry Fromson recently commented before HHS about the need to define maternity benefits broadly, while implementing the ACA.  Fromson emphasized the importance of defining maternity and newborn coverage to include prenatal care, hospitalization for delivery, and postpartum care to ensure that insurers do not deny these important elements of coverage to women the way they often do today. 

Prior to 2014, the effective date of the ACA, Pennsylvania must pass S.B. 1063 to provide women and newborns with insurance coverage for essential care.  WLP worked with the Maternity Care Coalition and Senator Farnese’s office on drafting the bill, and has joined the Insuring Motherhood Coalition, which seeks to pass S.B. 1063.  

To get involved in the campaign to insure healthy motherhood: 

Secretary Kathleen Sebelius
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201

Also see Women Care About Healthcare on WLP’s website.

About womenslawproject

The Women's Law Project creates a more just and equitable society by advancing the rights and status of all women throughout their lives. To this end, we engage in high-impact litigation, advocacy, and education.
This entry was posted in Childbirth, Health Care, Health insurance, Maternity Coverage, Pregnancy, Reproductive Rights, Women's health and tagged , , , , . Bookmark the permalink.

One Response to Pennsylvania: Stop Insurers from Denying Essential Maternity Coverage to Women

  1. How does (or why doesn’t) the Pregnancy Discrimination Act of 1978 apply here? Is it a technical difference between “maternity” and “pregnancy”?

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