The New York State Department of Financial Services (the “DFS”) is investigating health insurer compliance with contraceptive coverage requirements under New York Insurance Law, following an undercover sting of 15 insurers.
The DFS said that it discovered after its sting that certain New York health insurers were providing consumers with incorrect information about contraceptive coverage. Previously, the DFS had issued a circular letter to insurers seeking to ensure that all New York health insurers were providing full contraceptive coverage as required by law.
“New York law mandates that contraceptive coverage must be available with no copayments, deductibles, or any out-of-pocket costs, and also requires that insureds are provided accurate information about their rights to this coverage,” said the superintendent of the DFS, Maria T. Vullo. “Any insurer that is not providing full and accurate information about coverage requirements will be met with swift action to ensure full compliance with this important coverage protection. DFS's undercover sting identified insurers that provided inaccurate information about contraceptive coverage, and DFS will ensure that all New Yorkers have full access to reproductive health care as mandated by New York law.”
The DFS said that, in its sting, it identified 11 New York health insurers that had provided consumers with incorrect information about contraceptive coverage. According to the DFS, some health insurers incorrectly told callers that the consumer had to pay for contraceptive drugs and devices, when both New York law and the Affordable Care Act mandate such coverage. In addition, according to the DFS, several health insurers incorrectly stated that a particular contraceptive drug or device was not covered, or that co-payments were required when they were not.
Under New York law, all health plans in New York are required to provide coverage for all contraceptive drugs and devices and all non-grandfathered health plans must cover at least one form of contraception in each of the FDA-approved contraceptive delivery methods without co-pays, coinsurance, or deductibles, regardless of the future of the Affordable Care Act.
The DFS said that, as part of its investigation, it will take several steps to correct any violations it finds, including:
- Taking all necessary action to ensure that all health insurers in New York cover the full range of FDA-approved contraceptive delivery methods at no cost-sharing.
- Requesting a corrective action plan and related relief from health insurers found to have failed to provide accurate or complete information.
- Requesting information and documentation from health insurers regarding their coverage and reimbursement of contraceptive drugs and devices under health insurance policies. Specifically, the DFS will be requesting information about contraceptive claims submitted and whether the claims were appropriately paid, with no cost-sharing imposed. The DFS also will be requesting information about complaints and appeals involving contraceptive coverage.
Learn more: DFS Report; DFS Circular Letter.
Steven A. Meyerowitz
Steven A. Meyerowitz, a Harvard Law School graduate, is the founder and president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. He may be contacted at [email protected].