By Holly Landers, Senior Account Manager
Maryland Legislature passed House Bill 127 in 2019 allowing a Special Enrollment Period (SEP) for pregnant women. The new bill allows women becoming pregnant to enroll in a health plan or change their current plan. It also requires small employer (2-50 employees) health plans and individual health benefit plans to provide a Special Enrollment Period (SEP). During the special enrollment period, a woman who becomes pregnant, as certified by a health care provider, can enroll in a health benefit plan. The bill applies to all health benefit plans issued and renewed on or after January 1, 2020.
This bill filled a gap in the Affordable Care Act. Prior to the passing of this bill, the law allowed for a special enrollment period for a woman after giving birth. However, this did not apply to women who were uninsured at the time of becoming pregnant. This left open the possibility that the woman would not have access to pre-natal care services.
What is a special enrollment period?
A Special Enrollment Period (SEP) allows a individual to enroll in a health plan or change their current plan outside of the annual open enrollment period. They may enroll or change plans only if they have certain life events and are otherwise eligible to enroll in coverage. With the passing of this bill, women will now be able to enroll in coverage when they become pregnant.
Why is this bill important?
According to UCRHealth.org, receiving prenatal care helps to catch potential concerns and reduces the risk of complications. Not only are pregnant women without adequate health insurance at financial risk, but if they go without necessary prenatal care, their health and the health of their babies also are at risk. Babies of mothers who do not get prenatal care are three times more likely to have low birth weight. They are also five times more likely to die than babies born to mothers who get adequate care.
Having healthcare from the moment a woman confirms pregnancy is extremely important in reducing both maternal and fetal mortality. Access to quality obstetric services are essential to maternal and fetal health during and after pregnancy. This provides a healthy foundation for healthy families by ensuring that women have safe pregnancies and deliveries, giving the child the best possible outcome after birth. Requiring a special enrollment period for pregnant women ensures they and their children receive quality obstetric and pediatric care.
What does this mean for employers?
Small businesses are responsible for knowing the guidelines for this SEP. If the enrollment request and documentation is not submitted in the 90 days allotted, the enrollment will not be processed. This situation follows the same guidelines as other enrollments due to qualifying life events with the exception of the 90 days.
What are my next steps if I am pregnant?
You have 90 days to apply after learning you are pregnant. However, you should apply as soon as possible so you can receive prenatal care right away. In some cases, becoming pregnant may make you eligible for Medicaid, even if you were not eligible before. If you are already enrolled and become pregnant, and want to select a new plan, the effective date of your new plan will follow the 15th of the first of the following month if selection is made between the 1st and the 15th of the month. If plan election is made between the 15th and the end of the month, then the effective dates is the first of the next following month . This SEP is effective for the pregnant member of the household and any members already enrolled.
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