Senate Bill S5548A

                                BILL NUMBER:S5548A

TITLE OF BILL:  An act to amend the public health law, in relation to
making pregnancy a triggering event for purposes of enrollment in a
qualified health plan

PURPOSE:  Establishes pregnancy as a qualifying event making one
eligible for a special enrollment period under the New York State of
Health Marketplace.

SUMMARY OF PROVISIONS:

Section one adds a new Public Health Law § 2507 to require that, in
addition to any qualifying event under federal law, rule or
regulation, that makes one eligible for a special enrollment period,
the New York insurance exchange, known as the New York State of
Health, shall allow for the enrollment of a pregnant individual at any
time after the commencement of her pregnancy.

Section two provides the effect date.

JUSTIFICATION:  Under the federal Patient Protection and Affordable
Care Act (Pl.  111-148) generally individuals must enroll in qualified
health plans offered on health insurance exchanges during open
enrollment periods.  Federal law provides exceptions to this rule if
you have certain life events that qualify you for a special enrollment
              

period. Life events such as getting married, having a baby, losing
other coverage or gaining citizenship are several examples of
qualifying event under federal law.

Under current federal provisions, a pregnant woman is not eligible for
a special enrollment period until she gives birth, after which she and
her baby can enroll in coverage with a qualified health plan on the
exchange. This bill would permit New York women to enroll when become
pregnant, rather than having to wait until their baby is born. This
would enable women who become pregnant outside the three-month open
enrollment period to enroll in coverage, thus ensuring they seek
appropriate prenatal care and are not stuck with thousands of dollars
in bills for prenatal care and delivery. Without access to coverage,
women are more likely to forgo prenatal care which puts them at higher
risk for conditions that affect their own health as well as that of
the child, such as pregnancy related diabetes and high blood pressure.
While ideally most individuals will enroll in coverage prior to a life
event such as a pregnancy, the federal government already acknowledges
the need for a special enrollment period for women who have given
birth, this legislation will just allow for said enrollment upon
pregnancy.

LEGISLATIVE HISTORY: New bill.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE:  January 1St succeeding enactment and shall apply to
all qualified health plans issued, renewed or amended after such date;
provided, effective immediately the commissioner may adopt regulations
to implement.