February 21, 2017
Contact: Richard Loconte, 212-709-1691
DFS ANNOUNCES COMPREHENSIVE INVESTIGATION INTO INSURER CONTRACEPTIVE COVERAGE COMPLIANCE FOLLOWING UNDERCOVER STING
New York Law Requires That Insurers Fully Inform Consumers about Requirements to Cover Contraceptives without Co-payment, Coinsurance or Deductible
Undercover Sting Found That 11 Insurers Provided Inaccurate or Misleading Information
Investigation Led to Recent DFS Circular Letter Instructing Health Insurers of Their Responsibilities under New York Law to Provide Full Contraceptive Coverage
Financial Services Superintendent Maria T. Vullo today announced that the New York State Department of Financial Services (DFS) is conducting a comprehensive investigation of health insurer compliance with contraceptive coverage requirements under New York Insurance Law, following an undercover sting of 15 insurers. A report released today describes how DFS has discovered that certain New York health insurers are providing consumers with incorrect information about contraceptive coverage. As a result of this investigation, DFS recently issued a circular letter, which was announced by Governor Andrew M. Cuomo on January 21, 2017, ensuring that all New York health insurers are providing full contraceptive coverage as required by law.
“New York law mandates that contraceptive coverage must be available with no copayments, deductibles or any out-of-pocket costs, and also requires that insureds are provided accurate information about their rights to this coverage,” said Superintendent Vullo. “Any insurer that is not providing full and accurate information about coverage requirements will be met with swift action to ensure full compliance with this important coverage protection. DFS’s undercover sting identified insurers that provided inaccurate information about contraceptive coverage, and DFS will ensure that all New Yorkers have full access to reproductive health care as mandated by New York law.”
In its undercover sting, DFS has identified 11 New York health insurers that had provided consumers with incorrect information about contraceptive coverage. Some health insurers are incorrectly telling callers that the consumer must pay for contraceptive drugs and devices, when both New York law and the Affordable Care Act mandate such coverage. In addition, several health insurers incorrectly stated that a particular contraceptive drug or device is not covered, or that co-payments are required when they are not.
Under New York law, all health plans in New York are required to provide coverage for all contraceptive drugs and devices and all non-grandfathered health plans must cover at least one form of contraception in each of the FDA-approved contraceptive delivery methods without co-pays, coinsurance or deductibles, regardless of the future of the Affordable Care Act.
As part of this comprehensive investigation, DFS will take several steps to correct any violations they find, including:
- Taking all necessary action to ensure that all health insurers in New York cover the full range of FDA-approved contraceptive delivery methods at no cost-sharing.
- Requesting a corrective action plan and related relief from health insurers found to have failed to provide accurate or complete information.
- Requesting information and documentation from health insurers regarding their coverage and reimbursement of contraceptive drugs and devices under health insurance policies. Specifically, DFS will be requesting information about contraceptive claims submitted and whether the claims were appropriately paid, with no cost-sharing imposed. DFS will also be requesting information about complaints and appeals involving contraceptive coverage.
This announcement follows Governor Cuomo's recent actions earlier this month to secure reproductive health services in New York. Under Governor Cuomo's direction, the state took regulatory action to ensure that insurers:
- Provide coverage for all contraceptive drugs and devices and coverage for at least one form of contraception in each of the FDA-approved contraceptive delivery methods without co-pays, coinsurance, or deductibles, regardless of the future of the Affordable Care Act.
- Provide coverage for the dispensing of an initial three-month supply of a contraceptive to an insured person. For subsequent dispensing of the same contraceptive prescribed by the same health care provider and covered under the same policy or renewal, an insurer must allow coverage for the dispensing of the entire prescribed contraceptive supply, up to 12 months, at the same time.
- Provide coverage for abortion services that are medically necessary without co-pays, coinsurance, or deductibles (unless the plan is a high deductible plan).