Maternity Services Report.
In 2023 the Legislature directed the Office of the Insurance Commissioner (OIC) to analyze how health plans define, cover, and reimburse for maternity care services, including prenatal, delivery, and postnatal care, and make recommendations regarding methods to reduce or eliminate deductibles and other forms of cost sharing for maternity care services.? The OIC contracted with Milliman to provide actuarial analysis and provided a report with five cost sharing elimination options, including eliminating cost sharing for all maternity services, prenatal services only, labor and delivery services only, postnatal services only, and labor and delivery and postnatal service.
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Cost Sharing.
A health plan's cost sharing, the enrollee's share of the costs that they must pay out-of-pocket through a deductible, coinsurance, or copayment, is typically set by the health plan.? A deductible is the amount an enrollee must pay out-of-pocket for covered services before the health plan begins to pay for most services.? However, some services, like preventive services, must be covered without cost sharing and regardless of whether the deductible has been met.? Health care benefits that are not subject to the deductible are covered by the health plan before the enrollee has met the deductible.
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Federal law requires high deductible health plans (HDHPs) that have an associated health savings account (HSA) to meet a number of requirements to allow enrollees to maintain tax-exempt contributions and withdrawals for their HSA, including generally prohibiting HDHPs from providing benefits until the minimum deductible for the plan year is satisfied.? Federal law provides an exception to this prohibition for certain preventive care services.? For 2025 HDHPs must have a deductible of at least $1,650 for an individual plan or at least $3,300 for a family plan.
For health plans, including health plans offered to state and school employees, issued or renewed on or after January 1, 2026, that provide coverage for global maternity care billing codes for vaginal, cesarean section, and assisted delivery services, in-network delivery services are not subject to the enrollee's deductible.? Any cost sharing for in-network?delivery services paid by an enrollee must be applied toward the enrollee's deductible obligation.
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For a health plan that provides coverage of global maternity care billing codes for vaginal, cesarean section, and assisted delivery services and is offered as a qualifying health plan for an HSA (an HDHP), the health carrier must establish the plan's deductible for the coverage of the in-network delivery services at the minimum level necessary to preserve the enrollee's ability to claim tax-exempt contributions from their HSA under internal revenue service laws and regulations.
The substitute bill limits the provision that exempts labor and delivery services from an enrollee's health plan deductible to only apply to in-network delivery services for health plans that provide coverage for global maternity care billing codes for vaginal, cesarean section, and assisted delivery services.
(In support) Having a baby in this country and particularly in Washington state is very expensive.? Young parents are juggling high costs from housing to food to diapers.? Even just the cost of maternity services is cost-prohibitive for many people, and it is not uncommon for families to have deductibles of many thousands.? The cost of delivery can take years to pay off. ?This is an important bill for many and it increases health outcomes for kids.?
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Cost sharing schemes are a hindrance to young couples starting a family, which sometimes causes families to wait so long to have children that they experience reproductive health struggles, which adds to the cost.?
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This bill is a stop-gap measure.? This idea of continuing to promote cost sharing in order to somehow decrease costs has been discussed within the Universal Health Care Commission.? Focusing on the root cause of the increased costs and developing the Washington Health Trust is a better route to decrease costs to consumers.?
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(Opposed) None.
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(Other) The scope of this bill needs to be clearer and must be considered along with other bills the Legislature is considering. ?This bill requires copays and coinsurance to count toward a member's deductible, which means that consumers will reach their deductible faster, which means that other services may be covered at the first dollar sooner than usual.? This bill should be modified to clarify that it only applies to in-network providers and align definitions with existing global billing codes to ensure consistency and unintended consequences. ?
(In support) Representative Alicia Rule, prime sponsor; and Kathryn Lewandowsky, Whole Washington.