Massachusetts House Bill 5090 was recently signed into law and amends health insurance coverage related to abortion and abortion-related services. The requirements of the law went into effect for health insurance coverage issued in the Commonwealth of Massachusetts beginning on or after Jan. 1, 2023.
"Abortion" is defined as any medical treatment intended to induce the termination of, or to terminate, a clinically diagnosable pregnancy except for the purpose of producing a live birth. "Abortion" shall not include care related to a miscarriage.
The following services are “abortion-related services” when they are provided in conjunction with a payable abortion procedure:
- Pre-operative evaluation and examination.
- Pre-operative counseling.
- Laboratory services, including pregnancy testing, blood type, and Rh factor.
- Rh(D) immune globulin (human).
- Anesthesia (general or local).
- Post-operative care.
- Follow-up.
- Advice on contraception or referral to family planning services.
Also considered "abortion-related care'' when provided along with a covered surgical or medicine-based abortion are:
- Ultrasounds.
- Pre-abortion evaluation and examination.
- Post-abortion care.
Under the amended law:
- Health insurance carriers are required to cover all abortion and abortion-related care to persons covered under an insured health plan. Covered persons include subscribers, spouses, and dependents.
- Health insurance carriers may require that services be subject to plan network and utilization review procedures but are not permitted to impose any unreasonable restrictions or delays in access to care.
- The benefits, including the prescribing, dispensing, and administration of mifepristone with misoprostol, or misoprostol alone, shall not be subject to any deductible, coinsurance, copayment, or other cost-sharing requirements. An exception to the no cost-sharing requirement may exist for high deductible health plans.
Please note: A health insurance carrier is not required to offer coverage for abortion and abortion-related care to members of an employer that is a church or qualified church-controlled organization, if the employer asks that these services not be covered.
This information is being provided for your education and for the education of your patients who are enrolled in a ConnectiCare of Massachusetts, Inc. insured plan. If you have any questions, you may contact Provider Services at 860-674-5850 or 800-828-3407 8 a.m. to 6 p.m. Monday to Friday.
