November 9, 2015 — Many Rhode Island residents who have health plans through the state's insurance marketplace could lose their existing abortion care coverage and be enrolled automatically in a plan with less comprehensive abortion care benefits for 2016, the Providence Journal reports (Salit, Providence Journal, 11/5).
The Affordable Care Act (PL 111-148) does not prohibit abortion coverage and lets insurers determine whether they will offer it. However, the law requires health plans to segregate money collected for abortion coverage from other premiums. Insurers are not required to segregate the money for abortion coverage in cases of rape, incest or endangerment to the life of the woman.
The ACA requires marketplaces in all states by 2017 to include at least one multistate plan that does not cover abortion services beyond cases of rape, incest and endangerment to a woman's life (Women's Health Policy Report, 1/20).
Coverage Change Details
According to HealthSource RI, the state's insurance marketplace, a new state regulation mandates that health insurers selling coverage through the marketplace offer one plan at each of the coverage tiers -- bronze, silver and gold -- that excludes abortion coverage except in instances of rape or incest, or when a woman's life is in danger. The law was enacted after a Rhode Island resident sued the marketplace because it only included plans that covered more than the minimum of abortion coverage.
Meanwhile, insurers on the marketplace this year also are automatically reenrolling consumers who do not select a new plan back into their current plans, which might be modified slightly, or transferring them to comparable plans if their current coverage option is no longer available. Under the new mandate, insurers on the marketplace had to either introduce new plans with reduced abortion coverage or modify existing plans.
According to the Journal, two of the three insurers selling plans through the marketplace -- Blue Cross Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island -- are automatically enrolling members into existing plans that have reduced abortion care coverage. The third plan, United Healthcare, will not do so. Overall, about 9,000 residents could lose the 2015 level of abortion care coverage if they do not enroll in a new plan.
Consumers affected by the change have until Dec. 23 to choose a new plan. HSRI said all consumers affected by the change will be given a notice that includes details about the state regulation, a list of plans sold through HSRI with details about the extent of their abortion coverage, and a reminder notice about the Dec. 23 deadline. Further, according to HSRI, "Insurers are required to send their existing customers a notice that explains all of the changes from their existing plan to their new plan, including, if applicable, information about any change in abortion coverage" (Providence Journal, 11/5).