Insights

WA State Updates - 2015 Jan 21 No.01


On April 16, 2015, Insurance Commissioner Kreidler announced that eight insurance companies have agreed to engage in an ongoing plan to clarify information provided to consumers, specifically with respect to contraceptive benefits available to women under the PPACA. Under the PPACA, health insurers (and employer-sponsored non-grandfathered plans) must cover all federally approved methods of contraception with no copays or co-insurance, although they are permitted to use “reasonable medical management” techniques. The Insurance Commissioner found that representatives from these eight insurers provided inaccurate information to callers inquiring about contraceptive coverage benefits available and the cost-sharing for such benefits. The Insurance Commissioner has instructed the insurers to take the following corrective action:

Improve education and training for customer service and sales representatives.

Create clearer consumer materials for contraceptive benefits.

Ensure that forms and formularies accurately describe any additional steps women would have to take to access certain benefits.

Complete a self-assessment look-back, including an audit of calls and claims review in six and 12 months.

Employers sponsoring non-grandfathered group health plans should review the list of affected insurers and be aware that participants under the plan may be affected by the claims review going back six to 12 months in case questions are received. Commissioner Kreidler encourages any participant who does not believe they are getting the coverage required under the plan to file a complaint directly with his office.

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