KHI News Service

New coverage rules expected to have big impact in Kansas

By Jim McLean | August 01, 2012

The U.S. Department of Health and Human Services estimates that 450,000 Kansas women will benefit from federal rules that take effect today requiring health insurance companies to cover certain preventive and contraceptive services.

The new rules in the Affordable Care Act prohibit charging co-payments and deductibles for specific preventive services, including well-woman visits, breast-feeding support and supplies, and testing for HIV, gestational diabetes and human papillomavirus. Screening for domestic violence and counseling for victims are also among the preventive services required.

“This is an historic moment for Kansas women and their families,” said Anna Lambertson, executive director of the Kansas Health Consumer Coalition. “Eliminating expensive co-pays and other out-of-pocket costs will make it easier for women to get the services they need to stay healthy.”

Research indicates that people often delay getting health care because of cost concerns.

The new rules apply to most private health insurance plans, including those offered by large companies that self-insure their workers. However, many large employers in Kansas already cover many of the required services.

Suzanne Schrandt, a senior analyst at the Kansas Health Institute who tracks implementation of the Affordable Care Act, said the rules expand the number of preventive services that Kansas law requires state-regulated insurers to cover. The most controversial of those is the requirement that all new plans cover contraceptive services and family planning counseling. Some religious employers—such as churches—are exempt from this rule. But the exemption does not extend to employers such as hospitals and universities that may have a particular religious affiliation but employ persons of varied religious beliefs.

KHI News Service

Demonstrators protesting new Affordable Care Act regulations came from around the state for the rally on the south lawn of the Kansas Statehouse.

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“We know from work done by the Kaiser Family Foundation and others that a significant number of large group health plans are already providing coverage for contraceptives, so it is likely that the biggest change for Kansas insurers will be in the small group market,” Schrandt said.

Kansas was not among the 28 states that already required coverage of contraceptive services. So, some state-regulated insurance plans now will have to add them.

Catholic bishops from Kansas, like their counterparts across the United States, have criticized the new requirement for coverage of contraceptive services and stood with Gov. Sam Brownback at a recent Statehouse rally protesting that provision of the Affordable Care Act.

Brownback, a Republican and a Catholic, voted against the health reform law when he was in the U.S. Senate and as governor has continued to oppose the law. Catholic leaders oppose the use of contraceptives, although public opinion polls on religious issues have shown most Catholics support the requirement.

Mary Beth Chambers, a spokesperson for Blue Cross Blue Shield of Kansas, the state’s largest health insurer, said that while the company is implementing the new rules on schedule, some women may have to wait to access the covered services at no additional cost.

“What is important for Kansans to remember today is that only non-grandfather benefit plans are required to add these preventive services for women with no cost-sharing at their next anniversary date. For many women, this could be Jan. 1, 2013, or some later time next year,” Chambers said in an email to KHI News Service.

Medical-loss ratio

Another rule that takes effect today is expected to provide up to $4 million in insurance premium rebates to more than 45,000 Kansas families. The rule requires insurance companies to spend at least 80 percent of the premium dollars they collect on medical care or quality improvement. No more than 20 percent can be spent to cover salaries and other administrative costs or be retained as profits.

Companies that do not meet that standard are required to rebate the difference to customers. Kansans owed a rebate will receive a check in the mail, a credit to their account or a reduction in future premiums.

According to HHS, the Kansas insurance companies required to rebate premiums in the individual market are:

• Aetna Life Insurance Company

• Blue Cross Blue Shield of Kansas City

• Coventry Health & Life Insurance Company

• Golden Rule Health Insurance Company

• Humana Insurance Company, Inc.

• The MEGA Life and Health Insurance Company

Companies required to rebate premiums in the small-group market are:

• Blue Cross Blue Shield of Kansas City

• John Alden Life Insurance Company

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