State and federal anti-discrimination protections ensure that most employer-sponsored health insurance covers maternity expenses.1 However, it is very difficult—and sometimes impossible—for women to find coverage for maternity care in the individual health insurance market, where women buy coverage directly from insurers. In a study of the availability of maternity coverage in the individual market, the National Women’s Law Center found that the vast majority (87%) of individual health plans available to a 30-year-old woman across the country did not provide maternity coverage.2
A handful of states have recognized the importance of ensuring that maternity coverage—including prenatal, birth, and postpartum care—is a part of basic health care by establishing “benefit mandate” laws that require insurers to include coverage for maternity services in all group and individual health insurance policies sold in their state. Other states have adopted limited-scope mandate laws that require maternity coverage only for certain types of health plan carriers, certain types of maternity care, or for specific categories of individuals. Limited-scope mandate laws address the provision of maternity care but may fall short of providing women with full coverage for the care they need.
Starting in 2014, all new health plans sold to individuals and small businesses will be required to cover maternity and newborn care--these services are explicitly listed in the law as "essential health benefits" that the plans must provide.
States receive a “meets policy” if they require health plans sold in both the individual and group health insurance markets to cover maternity care. States receive a “limited policy” if they: require health plans to cover maternity care in either the individual or the group health insurance market (but not both); require certain types of health insurers (such as managed care organizations) to cover maternity care; or, if they only require insurers to offer maternity coverage as a benefit in health insurance plans but have not required that it be a mandated benefit in those plans. States that do not have any meaningful policy regarding maternity coverage receive a "no policy."
This is a new indicator for the 2010 Report Card.
|State||Strength of Policy||Change from 2007|
|Colorado 3||Limited Policy||N/A|
|District of Columbia||No Policy||N/A|
|New Hampshire||Limited Policy||N/A|
|New Jersey 4||Meets Policy||N/A|
|New Mexico||No Policy||N/A|
|New York 5||Meets Policy||N/A|
|North Carolina||No Policy||N/A|
|North Dakota||No Policy||N/A|
|Rhode Island||No Policy||N/A|
|South Carolina||No Policy||N/A|
|South Dakota||No Policy||N/A|
|Washington 6||Meets Policy||N/A|
|West Virginia||No Policy||N/A|
Data Sources: 1) National Women's Law Center, unpublished data, collected September 2008 and August 2010; 2) Kaiser Family Foundation, "Mandated Coverage of Maternity Care," January 2010, available at http://www.statehealthfacts.org/comparetable.jsp?ind=687&cat=7&sort=1558, accessed August 16, 2010.
1 Pub. L. No. 95-555, 92 Stat. 2076 (1978). The Pregnancy Discrimination Act of 1978 amended Title VII to specify that discrimination on the basis of pregnancy, childbirth, or related medical conditions constitutes unlawful sex discrimination under Title VII.
2 Brigette Courtot and Julia Kaye, National Women’s Law Center, Still Nowhere to Turn: Insurance Companies Treat Women Like a Pre-Existing Condition, October 2009, available at http://www.nwlc.org/resource/still-nowhere-turn-insurance-companies-trea..., accessed September 21, 2010.
3 Colorado's requirement for maternity coverage in the indvidiual market takes effect January 1, 2011. Though Colorado has a maternity coverage mandate for the group insurance market, the law exempts businesses with fewer than 15 employees and therefore does not expand upon the requirements of the federal Pregnancy Discrimination Act. For this reason, the state does not recieve credit for its group market maternity mandate.
4 In New Jersey, limited benefit "Basic and Essential" health plans are exempt from covering prenatal care but must cover costs associated with labor and delivery.
5 In New York, managed care organizations and nonprofit health insurers are required to cover maternity care in the individual market.
6 In Washington, limited benefit "catastrophic" health plans are exempt from the maternity mandate law.