State: all insurers failed to comply with Oregon Reproductive Health Equity Act

All 12 health insurance companies in the individual, small group, and large group markets in Oregon failed to comply fully with the Reproductive Health Equity Act (RHEA) at varying levels, according to reports released Thursday by the Oregon Department of Consumer and Business Services’ (DCBS) Division of Financial Regulation (DFR).

The agency found that most noncompliance involved improperly charging copays, coinsurance, and deductibles or failing to cover mandated benefits.

The division examined Aetna Life Insurance Company, BridgeSpan Health Company, Cigna Health and Life Insurance Company, HealthNet Health Plan of Oregon, Kaiser Foundation Health Plan of the Northwest, Moda Health Plan, PacificSource Health Plans, Providence Health Plan, Regence BlueCross BlueShield of Oregon, Samaritan Health Plans, UnitedHealthcare Insurance Company, and UnitedHealthcare of Oregon.

The examinations found that each of the 12 insurers failed to pay all eligible claims according to RHEA requirements. They applied copays, coinsurance, and deductibles, which are prohibited under RHEA for reproductive health and preventive care services. In some cases, insurers improperly denied claims for RHEA covered services.

In addition, the reports found that three insurers – Aetna, BridgeSpan, and Regence – failed to cover certain types of contraceptives or applied improper limitations on the amount or timing of when a member could refill a prescription.

Finally, examiners found that Cigna, HealthNet, Kaiser, and Samaritan each failed to properly resolve all consumer complaints and maintain adequate records demonstrating that they timely and adequately resolved member complaints, appeals, and grievances.

“RHEA is a critically important tool in the state’s effort to remove barriers to reproductive health care,” said Oregon Insurance Commissioner Andrew Stolfi, who is also the DCBS director. “As with every law, our insurers had an obligation to fully and timely implement each aspect of RHEA across all of their systems. It is disappointing to see that this did not happen. We will continue to monitor each insurer until they fully comply with RHEA and make whole any consumer harmed by these failures.”

Throughout the examination process, the division identified issues for each insurance company to immediately address to ensure members receive benefits mandated under the law, and progress towards full implementation of RHEA was observed and noted in several reports. Completion of these reports, which are similar to audits, is one of many steps the division takes in monitoring and addressing insurer compliance with the law.

Next steps include implementation of corrective action plans and ongoing data reporting and compliance monitoring with each insurer, as well as issuing regulatory guidance to clarify expectations. The DFR enforcement team will also now review the reports to determine appropriate penalties, restitution, and other action for each company.

Finally, the division plans to continue working with community partners to raise awareness of benefits available under RHEA and other reproductive health laws. Consumers who believe they have not received the services or benefits they are owed under the law are encouraged to contact their insurer or the division’s consumer advocacy team at 888-877-4894 (toll-free) or go to the DFR help page.

The Oregon Legislature passed House Bill 3391 (RHEA) in 2017. Starting in 2019, health insurance companies were required to provide, with no cost share, a specified list of reproductive health, sexual health, preventive care, and other health care services, including contraception and abortion.