Dependents Often Excluded From Maternity Care Coverage Under Employer-Sponsored Health Plans

August 7, 2012 — Many young adult women who will be able to maintain health insurance through their parents' health plans under the Affordable Care Act (PL 111-148) may not receive coverage for pregnancy, the Kaiser Health News/Washington Post reports.

Under the Pregnancy Discrimination Act of 1978, group health plans with 15 or more employees are required to provide maternity coverage for employees and their spouses, but the law does not cover dependents. Although specific data are not available, Dan Priga, head of Mercer's performance audit group, estimates that about 70% of employers that pay health claims directly elect not to provide maternity benefits for dependents.

The health reform law provides some assistance to young women who become pregnant while covered by their parents' health plans. The law requires new health plans to cover preventive health benefits recommended by the U.S. Preventive Services Task Force, including a range of screenings for pregnant women. In addition, starting this month, when non-grandfathered health plans begin a new plan year, insurers must cover many other health services for women, including breastfeeding support, supplies and counseling at no cost. Starting in 2014, the health reform law includes maternity and newborn care as one of the 10 essential health benefits, which all plans offered in the individual and small-group markets are required to cover. Large-group plans are not subject to the requirement.

Women's health advocates say companies and health plans should provide maternity benefits even if they do not have to do so. "For young girls, this is a basic health benefit they need," Debra Ness, president of the National Partnership for Women & Families, said, adding, "Why would they deny them access to a health benefit that's so essential?" (Andrews, Kaiser Health News/Washington Post, 8/6).