Employer health plans routinely cover pregnancy costs for workers and their spouses—but not necessarily daughters. According to a handful of new complaints filed with the federal government, that’s sex discrimination, and the Affordable Care Act doesn’t allow it.
If these complaints are successful, they could expand the benefits that health plans must cover under the Affordable Care Act.
The National Women’s Law Center is alleging that five institutions are discriminating against women by excluding pregnancy coverage from the health insurance benefits that they provide to their employees’ dependent children.
Denying comprehensive coverage for young women?
“In these cases, men’s needs are being met whether they’re dependents or not,” says Sharon Levin, director of federal reproductive health policy at the NWLC. “But for these young women, maternity benefits are not being provided. It’s a health benefit that only applies to women and [the absence of the benefit] denies them comprehensive coverage.”
The district-based advocacy group filed the complaints with the U.S. Department of Health and Human Services’ Office for Civil Rights. They allege that excluding coverage for maternity care for female dependent children violates Section 1557 of the Affordable Care Act, which bars discrimination in any health program or activity that receives federal financial assistance, such as research grants or subsidies, says Levin.
Marcia Greenberger, co-president of the NWLC, says it’s particularly important to address this issue now, since the health care overhaul allows adult children to stay on their parents’ health plans until they reach age 26 in most instances, even if they’re married or financially independent.
5 institutions named in the complaint
The five public and private institutions named in the complaints are:
- Battelle, a nonprofit research and development organization based in Columbus, Ohio;
- Beacon Health System in South Bend, Ind.;
- Auburn University in Auburn, Ala.;
- Gonzaga University in Spokane, Wash.; and,
- The Pennsylvania State System of Higher Education in Harrisburg, Pa.
The NWLC says the institutions employ more than 43,450 employees, but it does not have an estimate of how many people are insured.
Officials at two of the institutions named in the complaints said they believe they are complying with the law.
Employees at the Pennsylvania State System of Higher Education, which includes 14 of the state’s universities, can choose among several plans, including an HMO that provides full maternity coverage to covered dependent daughters, said Kenn Marshall, media relations manager, in a statement. “We are committed to complying with the law in all matters of our operation, including within our health care plan,” the statement said.
Gonzaga University director of community and public relations Mary Joan Hahn said in a statement, “It is our understanding that our health benefits plan is in compliance with the Affordable Care Act.”
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2.4 million pregnancies to women under age 25
Officials at Battelle declined to comment and the other two institutions did not respond Tuesday to questions about the complaints.
Employers with 15 or more workers that offer health insurance already have to provide maternity benefits for employees and their spouses under the Pregnancy Discrimination Act of 1978. But the law doesn’t apply to workers’ dependent children.
There are an estimated 2.4 million pregnancies annually among women under age 25, according to the NWLC.
The average age for women to have their first child was 25.4 years in 2010, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics.
Starting in 2014, small group and individual health plans that are not grandfathered under the law will be required to provide maternity and newborn care as one of 10 required “essential health benefits.” Large group plans aren’t required to abide by those essential benefit rules, however.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. It was produced with support from The SCAN Foundation.