Makes the commencement of pregnancy a triggering event for purposes of eligibility to enroll in a qualified health plan in the state health insurance exchange

5 Co-sponsors

• Liz Krueger
• Tony Avella
• Jesse Hamilton
• Velmanette Montgomery
• Marc Panepinto

BILL NUMBER:S5548A

Title of bill

An act to amend the public health law, in relation to making pregnancy a triggering event for purposes of enrollment in a qualified health plan

Purpose

Establishes pregnancy as a qualifying event making one eligible for a special enrollment period under the New York State of Health Marketplace.

Summary of provisions

Section one adds a new Public Health Law § 2507 to require that, in addition to any qualifying event under federal law, rule or regulation, that makes one eligible for a special enrollment period, the New York insurance exchange, known as the New York State of Health, shall allow for the enrollment of a pregnant individual at any time after the commencement of her pregnancy.

Section two provides the effect date.

Justification

Under the federal Patient Protection and Affordable Care Act (Pl. 111-148) generally individuals must enroll in qualified health plans offered on health insurance exchanges during open enrollment periods. Federal law provides exceptions to this rule if you have certain life events that qualify you for a special enrollment period. Life events such as getting married, having a baby, losing other coverage or gaining citizenship are several examples of qualifying event under federal law.

Under current federal provisions, a pregnant woman is not eligible for a special enrollment period until she gives birth, after which she and her baby can enroll in coverage with a qualified health plan on the exchange. This bill would permit New York women to enroll when become pregnant, rather than having to wait until their baby is born. This would enable women who become pregnant outside the three-month open enrollment period to enroll in coverage, thus ensuring they seek appropriate prenatal care and are not stuck with thousands of dollars in bills for prenatal care and delivery. Without access to coverage, women are more likely to forgo prenatal care which puts them at higher risk for conditions that affect their own health as well as that of the child, such as pregnancy related diabetes and high blood pressure. While ideally most individuals will enroll in coverage prior to a life event such as a pregnancy, the federal government already acknowledges the need for a special enrollment period for women who have given birth, this legislation will just allow for said enrollment upon pregnancy.

Legislative history

New bill.

Fiscal implications

None.

Effective date

January 1St succeeding enactment and shall apply to all qualified health plans issued, renewed or amended after such date; provided, effective immediately the commissioner may adopt regulations to implement.