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How California law protects insurance coverage for abortion

 

On May 2, 2022, a leaked document seemed to signal that the US Supreme Court is poised to overturn Roe vs. Wade — a move that would withdraw the federal protection for abortion.

The right to privacy is enshrined in the California State Constitution guaranteeing every Californian the ability to make fundamental health care decisions. That includes decisions about abortion, in consultation with their doctors. 

California law is clear that abortion care is basic health care and covered by most insurance. Below is a Q&A on questions you may have.

If you’re having difficulty understanding your coverage contact your insurer or call the Department of Insurance at 1-800-927-4357.

 

Is my private insurer required to cover my abortion?

Yes for most people. California law is clear that abortion care is basic health care, and most insurance plans must cover basic health care services. This requirement does not apply to employers that provide “self-funded” health care coverage 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. California law and the California Constitution prohibit private health insurers from discriminating against you for receiving any reproductive healthcare, including abortions. For example, insurers cannot refuse to provide you with insurance or change the pricing of your insurance plan because you had an abortion. 

 

Can my private insurer require prior authorization before I obtain an abortion?

Yes, although the law will change soon. Until December 31, 2022, your insurer may ask you to seek approval from the insurer before you receive a medication or surgical abortion, but your insurer cannot prevent you from obtaining an abortion or refuse to cover your abortion.

SB 245 requires that beginning in January 2023, insurance plans that cover abortion will be required to cover all abortion services with no prior authorization and with no cost sharing.

Additionally, you have a right to receive timely care. Urgent care appointments that require prior authorization must be scheduled within 96 hours (4 days) of your request, and non-urgent care appointments that require prior authorization must be scheduled within 15 days of your request. The process for obtaining prior authorization will vary depending on your insurer’s policies. If you are having difficulty getting timely access to any abortion services, please contact Consumer Services at 1-800-927-4357.

 

What do I do if there is no local abortion provider in my private insurance network?

If there is no local abortion provider in your insurance network or you aren’t able to make an appointment quickly, your insurer has an obligation to arrange for an appointment with a local out-of-network provider to ensure that you receive the care you need in a timely manner for the same price you would pay an in-network provider.  If you are having any problems with an insurer refusing to arrange and cover an out-of-network service or treatment when you were unable to access an in-network provider, please 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 will not need to get a referral from your doctor to receive an abortion. An insurer cannot require authorization or referral for obstetrical or gynecological care provided by an in-network OBGYN or family practice doctor.   Instead, you can make an appointment directly with a specialist. Along with abortion services, insurers may not require referrals for:

  • Pregnancy testing and prenatal care;
  • Contraceptive services, including sterilization and counseling;
  • Sexually transmitted disease screening, prevention services, and treatment; and 
  • HIV/AIDS screening and prevention services.

 

Does my Medi-Cal insurance cover my abortion?

Yes. If you are enrolled in Medi-Cal, visit the Department of Health Care Services’ information page.

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