Bulletin 97-1
Small Employer Maternity Coverage Requirements
The Department of Insurance has been asked to clarify its position
regarding the guaranteed availability requirements of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA).
Maternity Coverage
Specifically, the question has been asked whether carriers must offer
maternity coverage to all small employers. It is our understanding that carriers offering
coverage in the small employer market must offer maternity coverage to small employers of
all group sizes.
HIPAA does not permit issuers to establish a participation requirement that exceeds the
number of eligible individuals or employees of an employer. State law also requires any
participation requirement to be applied uniformly to all small employers of a given size.
Contract provisions that condition coverage or benefits, including maternity benefits, on
the size of a small employer will not be permitted under HIPAA and state law.
The law does not require all small employers to provide maternity coverage and it does not
prohibit issuers from also offering insurance without maternity coverage.
Effective Date
The department points out that the effective date of Senate bill 60 is May 1, 1997. The
changes required by state law will be effective before HIPAA in some cases. For instance,
the requirements regarding pre-existing condition exclusions are effective May 1, 1997 for
small employer coverage without regard to the plan year of the employer.
DATED this 11th day of June, 1997.
Insurance Commissioner |