In-vitro fertilization exemptions backed for some insurers

Keep habilitative services rules, 2 say

Some insurance plans sold to individual consumers and small businesses would continue to be exempt from a requirement to cover in-vitro fertilization under a recommendation made by members of a state committee on Tuesday.

The two members of the Arkansas Health Insurance Marketplace board of director's plan management committee also recommended that Arkansas keep the same requirements for the coverage of habilitative services, including therapies for the developmentally disabled, that the state adopted in 2013, rather than adopt a federally drafted requirement.

The recommendations are part of a required update to Arkansas' "benchmark" plan, which is used to set the standard for benefits that other plans are required to cover to comply with the 2010 Patient Protection and Affordable Care Act.

The full marketplace board, which is using money from a $99.9 million federal grant to establish Arkansas-based health insurance exchanges for individual consumers and small businesses, is expected to vote on the benchmark plan recommendation next month.

The board's choice will then go to the Centers for Medicare and Medicaid Services for approval.

Arkansas' current benchmark plan, selected in 2012 by then-Insurance Commissioner Jay Bradford, is Arkansas Blue Cross and Blue Shield's Health Advantage Point of Service Plan for small businesses.

That plan doesn't cover in-vitro fertilization. Because it is offered by a health maintenance organization, it is exempt from a 1987 state law that requires individual plans and other types of small group plans to cover the procedure.

As a result, other individual and small group HMO plans in the state also remain exempt from the requirement.

On Tuesday, plan management committee members Annabelle Imber Tuck and Mike Castleberry both voted to recommend the Health Advantage Gold Bluechoice Open Access Point of Service plan as the benchmark plan for Arkansas starting in 2017.

The committee's two other voting members, Fred Bean and John Denery, did not attend the meeting.

Because the Health Advantage plan doesn't cover in-vitro fertilization, choosing it as the benchmark would mean that individual and small group plans would remain exempt from the requirement to cover the procedure.

The vote was taken after audience members, most of whom were insurance company representatives, split 5-5, with some members not voting, in a show of hands on whether the marketplace board should choose the Health Advantage plan or a Blue Cross Preferred Provider Organization plan that does cover in-vitro fertilization.

The split included two Arkansas Blue Cross representatives who voted for the Health Advantage plan and two who voted for the PPO plan.

Cal Kellogg, the company's executive vice president and chief strategy officer, voted for the PPO plan along with former U.S. Rep. Vic Snyder, now Arkansas Blue Cross' corporate medical director for external affairs.

"My perspective is, it's forcing an unlevel playing field between HMOs and insurance companies," Kellogg said after the meeting.

Snyder added that covering in-vitro fertilization is a "healthy benefit" that can reduce the risk of premature births.

Tuck, a former state Supreme Court justice, said choosing the plan would maintain the policy set by the state Legislature.

"They could have changed it during the legislative session if they wanted to, and they didn't," Tuck said.

Tuck and Castleberry also favored keeping the state habilitative services coverage requirement, rather than adopting a definition released this year by the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services.

Tuck said she prefers Arkansas' requirement because, unlike the federal definition, it refers specifically to services and equipment for people with developmental disabilities.

The audience members voted 13-0 in support of keeping the state requirement.

Metro on 05/20/2015

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