Abortion is covered by most insurance pans in California, even after the Supreme Court’s decision to overturn the landmark Roe v. Wade, the state’s Insurance Commissioner said Friday in a statement.
The Court’s ruling allows states to ban abortions, but California already had a raft of measures in place to protect access to abortions.
California protects abortion access through privacy rights, protected in the State Constitution that ensure residents have the ability to make health care decisions, including on abortion.
“California law is clear that we protect reproductive freedom and insurance coverage for abortion. Defending all people’s right to healthcare is a top priority for me and the Department of Insurance,” said Insurance Commissioner Ricardo Lara. “That’s why we have assembled the facts about Californians’ rights on insurance coverage for reproductive health care. We want to help cut through the clutter and make sure consumers know that California law and the Department of Insurance are there to protect them.”
In 1972, California voters added a right to privacy to the state constitution. State courts have cited that right to privacy while upholding many of the state’s abortion laws. Roe v. Wade, the U.S. Supreme Court’s landmark 1973 decision that prevents states from banning all abortions, was based on the U.S. Constitution’s implied right to privacy.
The following information was provided by the California Department of Insurance:
Is my private insurer required to cover my abortion?
Yes, for most people. California’s laws are clear that abortion is a basic health care need and most insurances need to cover the procedure. This does not apply to employers who prove “self-funded” insurance or grandfathered plans. If you’re having difficulty understanding your coverage contact your insurer or call the Department of Insurance at 1-800-927-4357.
Can my private insurer discriminate against me for having an abortion?
No. The California Constitution prohibits private health insurers from discriminating against anyone getting any kind of reproductive health procedure. Insurers cannot refuse to provide you with insurance or change pricing of an insurance plan because of an abortion.
Can my private insurer require prior authorization before I obtain an abortion?
Yes, until Dec. 31,2022 when the law will change. Insurers may ask for approval from the insurer before an abortion procedure, but they cannot refuse to cover or prevent someone from receiving an abortion.
Senate Bill No. 245 requires insurance plans that already cover abortion to cover all abortion services with no authorization and no cost sharing. This will be in effect starting January 2023.
Additionally, you will have the right to receive timely care.
What do I do if there is no local abortion provider in my private insurance network?
If there is no local abortion provider or timely appointments your health care provide has an obligation to arrange appointments with local out-of-network in a timely manner for the same price you would pay with an in-network provider.
If there is an issue accessing appointments through your insurer, contact the Department of Insurance at 1-800-927-4357.
Can my private insurer require me to receive a referral from my doctor for an abortion?
No, you do not need a referral code from your doctor. An insurer cannot require a referral for gynecological care provided by an in-network OBGYN. You can make appointments directly with a specialist, including abortion services.
Insurers should not require referrals for:
- Pregnancy testing and prenatal care
- Contraceptive services, including sterilization and counseling
- HIV/AIDS screening and prevention services
Does my Medi-Cal insurance cover my abortion?
Yes, the Medi-Cal QP program offers temporary covered care to low-income pregnant patients. It provides prenatal care and prescription drugs related to pregnancy. Any patient who believes they are pregnant is eligible, patients will have to find a qualified provider to enroll in.
If you’re having difficulty understanding your coverage contact your insurer or call the Department of Insurance at 1-800-927-4357.
