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Published February 06, 2013, 11:30 PM

Answers about maternity coverage and long-term care

This week, I am answering readers’ questions about maternity coverage requirements in the new health insurance exchanges, long-term-care insurance and switching employer health plans.

By: Michelle Andrews, Special to The Washington Post, INFORUM

This week, I am answering readers’ questions about maternity coverage requirements in the new health insurance exchanges, long-term-care insurance and switching employer health plans.

Q Under the Affordable Care Act, will all plans have to cover maternity benefits in 2014? I do not want maternity coverage. Will I have the option to decline maternity coverage in an individual plan?

A Maternity and newborn care are together considered one of the 10 “essential health benefits” that most individual and small-group plans sold on the state-based health insurance exchanges and the private market will be required to offer in 2014. (If the plans have grandfathered status under the law, they’ll be exempt, however.)

This requirement will bring small-group and individual plans into line with the coverage that’s already required under the Pregnancy Discrimination Act for companies with 15 or more workers, says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a research and policy center on issues of sexual and reproductive health.

“Not offering maternity coverage when you cover other types of care is sex discrimination,” he says. “The Affordable Care Act is trying to close that loophole.”

Declining coverage will not be an option in an individual or small-group plan.

Q If I purchase a long-term-care insurance policy in my 60s and don’t need to use it for another 10 or 20 years, what happens in the event that the company that I’ve contracted with goes out of business or changes corporate structure and assumes a different identity? Are there any states that have protections in place for cases like this?

A Every state and the District of Columbia have life and health insurance guaranty associations that protect consumers if they buy a long-term-care policy from an insurer that later fails. Funded by insurers that do business in a state, the associations ensure that coverage continues and benefits are provided even if an insurer is no longer in existence. The associations do this by either taking over the policies themselves or placing them with another, healthy insurer.

Insolvencies are uncommon but not unheard of, says Bonnie Burns, a policy specialist at California Health Advocates, a Medicare advocacy and education organization.

There is one potential wrinkle, however, she says. Although your coverage and benefits will continue if your insurer fails, each state caps the maximum amount that policies taken over by the guaranty association pay out, typically between $100,000 and $300,000.

It’s much more common for insurers to change hands or sell their long-term-care insurance business than to shut down. If that happens, your coverage shouldn’t be jeopardized.

“It doesn’t affect the policy,” Burns says. “That’s a legally binding contract that’s guaranteed under state law.”

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