A House investigation has found that some leading health insurance companies deny maternity coverage as a pre-existing condition in the individual health insurance market.
According to an investigation conducted by the House Committee on Energy and Commerce, pregnant women, expectant fathers and families in the process of adoption are unable to obtain health insurance in the individual market, a committee memo said.
In addition, many health insurance plans in the individual market do not provide insurance coverage for medical costs related to pregnancy, and health insurance companies have business plans to reduce the coverage of maternity expenses, according to the memo issued to the committee by Henry Waxman (D-Calif.), chairman of the House Committee on Energy and Commerce, and Bart Stupak (D-Mich.), chairman of the Subcommittee on Oversight and Investigations.
Waxman said the committee has been investigating maternity coverage in the individual health insurance market since March.
"The maternity coverage practices described in this memorandum are those that exist in today's market," he said. "In all likelihood, they would have continued in the future absent the passage of health reform legislation. One important benefit of the Affordable Care Act, which was signed into law on March 23, 2010, is the fundamental reform of maternity coverage."
According to Waxman, the four largest for-profit health insurance companies, Aetna, Humana, UnitedHealth Group and WellPoint, have listed pregnancy as a medical condition that would result in an automatic denial of individual health insurance coverage.
He said insurers often exclude maternity coverage from plans offered to individuals who are not expecting at the time they subscribe.
One company didn't offer any policies in the individual market that covered maternity expenses in 2009 or 2010, except as mandated by law in one state, the memo stated. In California, nine of the 14 plans offered by one company provided no benefits for pregnancy-related medical claims.
One company's largest subsidiary in the individual market does not offer benefits for routine pregnancies in half their plans in the individual market, according to the findings. Another offers maternity coverage as required by law in Pennsylvania, Kansas and Maryland, but otherwise has no individual policies that provide maternity coverage, the investigation found.
In addition, the committee found insurance companies "severely limit" the benefits they provide under maternity riders.
Waxman said the committee conducted the investigation because millions of people seek health insurance through the individual market. In 2008, the latest year for which data is available, approximately 15.7 million adults under 65 received their healthcare coverage through individual health insurance policies.
He said the investigation was based on information voluntarily provided to the committee by Aetna, Humana, UnitedHealth Group and WellPoint. The four companies covered 2.8 million people in the individual health insurance market in 2009