In Colorado, pregnancy makes men, children uninsurable, too

When commercial pilot Matt Temme of Castle Rock was furloughed by his  employer last June, he lost his health insurance. Temme’s wife had coverage through her employer, but adding Temme and his son would have cost $800 a month— an expensive proposition for a family who had just lost a portion of their income. So Temme went looking on the individual market for insurance. He’s a healthy 41-year-old. His son is a healthy 6-year-old.

“I never imagined I would have a problem,” he said.

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He applied for a plan through CIGNA, the insurance company that had provided the coverage at his workplace. He was denied. The reason? His wife was pregnant.

“It’s against the company’s policy to insure anyone who is pregnant or anyone who is married to someone who is pregnant,” he said.

Temme went on to seek coverage with a few other insurance companies. He got the same answer. He tried to obtain short-term, six-month coverage, which would have expired before his wife’s due date. He was turned down for that plan, too.

“It was a rude awakening,” Temme told The Colorado Independent. “I’ve always been employed. My wife has always been employed. We’ve never thought about health coverage. Until I was in this situation, I’ve never given two thoughts to my health care coverage.”

It’s just business

Asked about turning down husbands of pregnant women, CIGNA’s spokeswoman Gwyn Dilday said it’s just company policy.

“Typically insurers do not offer individuals with a pregnant spouse or partner individual coverage because of the risk associated with pregnancy and the potential risk of complications to a baby. Like other health plans, CIGNA HealthCare of Colorado follows industry standards in its underwriting policies, which have been approved by Colorado regulators. Once the child is born, an individual may reapply for coverage.”

CIGNA wouldn’t clarify exactly how a man’s health insurance could be affected by a spouse’s pregnancy when she has her own separate insurance. But Dayle Axman, supervisor of the Life and Health section of Consumer Affairs and the Colorado Division of Insurance, explained that under Colorado law, a newborn is technically covered under both the mother’s insurance and the father’s insurance for the first 31 days of his or her life.

“Insurance carriers are concerned that if the baby was born prematurely or with some illnesses that they would immediately have a claim,” Axman said. “So I believe that’s why most of them will turn down the father if he is applying for coverage at the time his wife is pregnant.”

Axman wasn’t sure if all insurance companies in Colorado denied men individual coverage if their wives were pregnant. But she said she can confirm that the question appears on the applications for insurance put out by several companies here.

Temme understands the rationale driving the insurance company denials, even if it seems like something from a novel exploring either modern-era bureaucratic folly or capitalist excess.

“I understand as the system currently is, as flawed as it is, that the insurance companies are in it to make money, so they’re going to manage their risk. I understand their reasoning, I guess. But it just seemed a little absurd to me.”

Covering Colorado

“In Colorado, individuals who are unable to find private insurance have the option of seeking coverage from the state’s high-risk pool, CoverColorado,” noted CIGNA’s Dilday, in her response to questions from The Colorado Independent about why Temme was turned down.

That’s where Temme ultimately turned. And he’s not alone. CoverColorado Executive Director Suzanne Bragg-Gamble said the state’s high-risk insurance pool is currently seeing between 400 and 500 new applications each month from people who have been turned down by Colorado’s insurance companies.

“Many of these seem reasonable. Others are like Matt, where you might think ‘Wow, I can’t believe you were turned down,'” she said.

It’s a number that has been rising, said Bragg-Gamble, as increasing numbers of Coloradans are being laid off, losing their health insurance and finding that they can’t obtain coverage on the individual market.

The nonprofit CoverColorado program established by the Colorado legislature in 1991 now insures roughly 10,500 Coloradans— a 51 percent increase since mid-2007, according to Bragg-Gamble. Funding for the program comes 50 percent from member premiums, 25 percent from a health insurance industry assessment, and 25 percent from Colorado’s unclaimed property fund.

Obtaining coverage from CoverColorado isn’t cheap— its rates are set at 140 percent of standard rates on the individual market. A 39-year-old female in Denver would pay $468.29 for a plan with a $1,000 deductible, for example, and a 39-year-old male in Denver would pay $298.37, for the same plan.

For Temme, who now had missed the open-enrollment period for his wife’s insurance, it was the only option.

“There was nowhere else I could go,” he said. “I thought it was ironic that these companies that are fighting tooth and nail against the public option basically forced me onto it.”

“They dish all the high-risk people onto [CoverColorado], and then they keep all the healthy people.”

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Katie Redding

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