Consumers have the right under the ACA to no-cost preventive services including certain surgical procedures.
DENVER - The Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), is reminding health insurance companies of their obligation to ensure that individuals seeking contraceptive services, including tubal ligation surgery, are able to access these services timely and without costs for the insured member. That means that no copayments, deductibles or coinsurance amounts are to be charged to the individual.
“The Division has recently become aware of instances where individuals may have received erroneous information that they would be responsible for some portion of costs for a surgical sterilization procedure,” said Colorado Insurance Commissioner Michael Conway. “The Affordable Care Act specifies that this procedure, as well as 17 categories of FDA-approved contraception, are available to nearly all insured Coloradans at no additional cost beyond their monthly premiums.”
Under the ACA, private health plans (including individual, small group and large group) must provide coverage for a range of recommended preventive services, and may not impose copayments, deductibles, or co-insurance (collectively referred to as “cost-sharing”) on patients receiving these services at in-network providers.
Health insurance companies are also reminded of their obligation to allow for 12-month oral birth control prescriptions, in compliance with Colorado State law.
The DOI also wants Coloradans to know that if any of the following happen to you, you should contact the Division of Insurance for help.
- Your contraception (including Plan B) isn’t being covered at no-cost to you
- The contraception that works best for you, as determined by you and your doctor, isn’t being covered at all or is not being provided at no-cost to you
- You want 12 months of oral contraception or three months of a vaginal ring, but your insurance won’t cover that quantity.
The DOI has developed a consumer resource for those with questions about contraception coverage, Contraception Health Care Rights and Resources. If you feel you have been unfairly denied or overcharged for a contraception benefit by your health insurance, you can file a complaint with the Division of Insurance at 303-894-7490 / DORA_Insurance@state.co.us / doi.colorado.gov (click on “File a Complaint”).
About the Division of Insurance:
The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), regulates the insurance industry and assists consumers and other stakeholders with insurance issues. Visit doi.colorado.gov for more information or call 303-894-7499 / toll free 800-930-3745.
DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado. Consumer protection is our mission. Visit dora.colorado.gov for more information or call 303-894-7855 / toll free 800-886-7675.