Opinion: Your health insurance may not be as good your state requires — and it’s perfectly legal
About 80% of large companies self-insure, meaning that their employee health plans don't have to meet state standards.
In 2017, the Massachusetts state Legislature passed a law to ensure ease of access to birth control. It says there should be no copay for hormonal birth control prescriptions. It also allows women to fill a 12-month prescription at once. Infertility care has similar protections. The state mandates that plans cover “medically necessary expenses of diagnosis and treatment of infertility” if the insurance provides other pregnancy-related benefits. This includes comprehensive coverage of even costly treatments such as in vitro fertilization.
However, health plans covering 57% of Massachusetts residents, and a similar rate nationally, don’t have to comply with state laws like these. Why? Because many companies are “self-insured.”
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