Colorado women offered small-group health insurance plans or looking to buy plans on the individual market and expecting them to cover birth control should be sure to read the fine print. Plans vary widely on the birth control coverage they provide, and the reasoning guiding the products on offer is often unclear. What’s more, denials of service are often buried in contract sections newcomers to the market are likely to skim or not read at all.
According to federal law, all employer-sponsored plans in the United States are mandated to cover birth control for any company employing more than 15 people. In Colorado, however, there is no mandate to cover birth control for employer-sponsored plans with less than 15 people or plans that are purchased on the individual market.
The coming legislative session could change that: Rep. K. Jerry Frangas, a Democrat from Denver, recently proposed a bill that would mandate insurance companies to cover both maternity and birth control across the board.
The Colorado Independent investigated maternity coverage options in the state and found a tangle of options women and families might cobble together that even the insurance agents paid to sell them wouldn’t recommend. The options were expensive; the coverage was undependable.
During the last two weeks, The Colorado Independent set out to find how many companies cover birth control and also ran up against a woefully inadequate consumer market.
Among seven insurance companies offering small-group policies, many said they would only provide birth control in small-group plans if it’s something the employer wants. That means that some women who have health insurance through their employer may not have the option to choose a plan that covers birth control.
On the individual market, The Colorado Independent questioned the nine companies who offer coverage through ehealthinsurance.com. Three companies said they offer birth control coverage on most of their plans; three don’t at all; one covers birth control devices, but not their implantation; one covers birth control only for plans with that cover brand-name and generic drugs (which were only available at ehealthinsurance.com with the purchase of a rider) and one company still has not yet responded to inquiries. Moreover, whether a plan covers birth control is not always readily available information: it’s generally buried in the “exclusions and limitations” section.
Aetna, according to spokesman Scot Roskelley, covers the following on its small group plans and all individual plans with pharmacy and outpatient benefits: oral contraceptives, diaphragms, injectable contraceptives, contraceptive patches, contraceptive rings, implantable contraceptives and intrauterine devices (including their insertion and removal) and tubal litigation.
Anthem Blue Cross Blue Shield also covered most forms of birth control on its small-group plans and “most” of its individual plans, according to spokeswoman Sally Kueskin. Kaiser Permanente spokeswoman Amy Smith said the same, though she couldn’t confirm whether the company covered tubal litigation.
“I don’t know why this particular legislator is looking at this mandate,” Kueskin said. “It seems like it would be just passing legislation to pass legislation from what I could find out from our plans.”
But not all plans are as generous to women as Anthem, Kaiser or Aetna.
At Humana, for example, spokeswoman Anna Hobbs confirmed that the company offers oral contraception and other birth control devices on its small-group plans with co-pays ranging from $5 to $15. She is still confirming whether or not these plans cover implantation of devices as well. On its individual plans, it will pay for birth control pills and devices, but not for their implantation.
At Rocky Mountain Health Plans, spokeswoman Kayla Arnesen said that group and individual prescription drug plans cover birth control. However, she said, “It needs to be noted that members must have prescription drug coverage for brand and generic drugs as a part of their medical plan in order to receive the benefit. Some medical plans do not include prescription drug coverage.”
In fact, none of the Rocky Mountain Health Plans listed at ehealthinsurance.com for a Denver zip code covered brand-name drugs–although members could purchase an additional rider for coverage.
On United Health plans, underwritten by Golden Rule, birth control is covered on many small-group plans, though some people would have to purchase a prescription rider in order to have birth control covered, according to spokesman Will Shanley.
Asked about individual plans, Golden Rule released this statement: “Whether Golden Rule’s individual plans cover contraceptives depends upon the state and the plan. In Colorado, some of our current customers have coverage for contraceptives and other do not.”
But asked to clarify whether the company actually sold plans that covered contraception, it turned out that it didn’t — unless the contraception was for medical reasons, and the patient had coverage for outpatient prescription drugs.
Golden Rule did not respond to inquiries about why it didn’t cover birth control on individual plans.
CIGNA small-group plans also cover birth control if the employer wants it, said spokeswoman Kate Wilson. The company does not cover birth control on any individual plans, according to spokeswoman Gwyn Dilday.
CIGNA also did not explain why it does not cover birth control. However, after repeated inquiries from The Colorado Independent, Dilday did say that the company had decided to start covering birth control in January.
“We regularly make enhancements to our individual products throughout the country. This is one of the things that is being added,” she said.
“I’m told that we cover such services when medically required, which I believe is consistent with other carriers in the individual health market in Colorado,” he wrote in an email.
Celtic has not yet answered inquiries from The Colorado Independent about its birth control coverage.
This story has been corrected to indicate that Humana does offer coverage for oral contraception on all its small-group plans. This story has also been updated with information provided from Rocky Mountain Health Plans in response to earlier requests from The Colorado Independent.