As most people know by now, the Affordable Care Act created a number of changes in the individual health insurance market. Not only are all plans now guaranteed issue with no pre-existing condition exclusions, limitations, or surcharges, individual health policies now cover all essential benefits as well. That means that conditions like maternity, which in the past was not a covered benefit on individual plans or, at best, may have been offered as an expensive rider with a long waiting period, is now covered from day one.
However, as the Obama administration clarified Monday, for women who are not yet ready to have a family, health insurance companies “must cover all forms of female contraception, including the patch and intrauterine devices, without imposing co-payments or other charges” (source: the New York Times). Birth control is considered a preventive benefit under the health reform law, so all ACA-compliant plans, whether sold through the federal or state exchange or in the outside market, must cover all forms of birth control.
Additionally, as reported by the New York Times, “the Obama administration said that insurers must cover genetic testing and counseling for certain women who have a family history of breast or ovarian cancer. Specifically, it said, insurers must cover testing for mutations in the BRCA1 and BRCA2 genes, which can increase a woman’s risk of developing breast or ovarian cancer.”
Of course, agents with a private exchange website do not need to know the specifics about each policy – that’s something the call center representative will discuss with your clients – but it is helpful to understand general provisions that apply to all plans regardless of carrier and regardless of whether they’re purchased on the exchange or not. The enhanced benefits are certainly worth sharing with prospective clients and, for some people, could be the deciding factor that makes them choose to purchase individual health insurance coverage.