S.201/A.2656 – Pregnancy SEP

This legislation would allow pregnant women to enroll in the state health insurance exchange at any time without fee or waiting period. The New York Health Plan Association (HPA) opposes S.201/A.2656 as it is unnecessary.

The New York State of Health (NYSOH), the state’s official Marketplace, currently includes pregnancy as a “qualifying life event” that falls under the rules for a “Special Enrollment Period” or SEP, which make it possible for New Yorkers to enroll in or change their coverage through a Qualified Health Plan outside of the normal Open Enrollment Period. Pregnancy certified by a health care practitioner is one of eight such qualifying life events that make people eligible for special enrollment[1]. Further, the state does not allow for any penalties to be imposed for enrolling during a SEP.

When the NYSOH was created under the Affordable Care Act, HPA and its member plans worked with the state on its development and in ensuring it was a success. Today, this robust health insurance exchange currently provides coverage for nearly 6.9 million individuals, or one in three New Yorkers across the state, including more than 214,000 enrolled in a Qualified Health Plan.*

Since the outset of the coronavirus pandemic nearly three years ago, health plans have been working closely with the state and partners in the provider community to combat coronavirus and ensure patients have access to needed care. Plans also supported initiatives to ensure New Yorkers were able to access and maintain health insurance coverage. Efforts in these areas included extending the open enrollment period to enable any New Yorkers who lost coverage due to the public health emergency to immediately access new coverage options through the NYSOH as well as helping businesses and individuals who needed extra time to pay premiums.

Everyone deserves affordable, comprehensive coverage, and health plans are proud of the role they play in working to ensure New Yorkers have access to high-quality and affordable health insurance options. The existing SEP rules that allow pregnant women to enroll in a health plan through the NYSOH at any time guarantee they can get coverage and make this bill unnecessary.

For these reasons, HPA opposes S.201/A.2656.

[1] https://info.nystateofhealth.ny.gov/SpecialEnrollmentPeriods#:~:text=Qualifying%20Life%20Events%20include%3A%201%20%20Loss%20of,certified%20by%20a%20health%20care%20practitioner%20More%20items