This bill matters because it addresses a critical gap in health insurance access that can have serious consequences for maternal and infant health. Currently, someone could become pregnant outside of the regular open enrollment period and face months without necessary health coverage, potentially leading to delayed prenatal care or no care at all. This lack of timely care is a major contributing factor to the United States' relatively high maternal mortality rate, particularly among women of color.
If this bill becomes law, pregnant individuals would gain immediate access to care, which the bill argues can improve health outcomes for both mothers and babies, potentially reducing complications and long-term healthcare costs. If it does not pass, many pregnant individuals would continue to face barriers to obtaining immediate health insurance coverage, potentially leading to worse health outcomes, higher out-of-pocket costs, and continued disparities in maternal health.
KEY PROVISIONS
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PROVISION 01
Creates a special enrollment period for pregnant individuals on health insurance Exchanges (such as Healthcare.gov), beginning when the pregnancy is reported.
Ensures pregnant individuals can get health coverage through the ACA marketplaces as soon as they report their pregnancy, avoiding delays in care.
PROVISION 02
Establishes a special enrollment period for pregnant individuals directly with health insurance issuers in the individual market, beginning when the pregnancy is reported.
Allows pregnant individuals to enroll in new or updated health plans directly from insurance companies outside of the Exchanges, improving access to coverage options.
PROVISION 03
Mandates a special enrollment period for pregnant individuals within employer-sponsored group health plans, beginning when the pregnancy is reported or confirmed by a healthcare provider.
Ensures employees and their eligible dependents can get coverage for pregnancy through workplace plans immediately upon pregnancy, regardless of the regular enrollment schedule.
PROVISION 04
Requires the Secretary to issue regulations establishing a time period for pregnant individuals to enroll under employer-sponsored plans once the special enrollment period begins.
Provides clarity and consistency for how long pregnant individuals have to enroll after they become eligible for this new special enrollment period.
This bill matters because it addresses a critical gap in health insurance access that can have serious consequences for maternal and infant health. Currently, someone could become pregnant outside of the regular open enrollment period and face months without necessary health coverage, potentially leading to delayed prenatal care or no care at all. This lack of timely care is a major contributing factor to the United States' relatively high maternal mortality rate, particularly among women of color.
If this bill becomes law, pregnant individuals would gain immediate access to care, which the bill argues can improve health outcomes for both mothers and babies, potentially reducing complications and long-term healthcare costs. If it does not pass, many pregnant individuals would continue to face barriers to obtaining immediate health insurance coverage, potentially leading to worse health outcomes, higher out-of-pocket costs, and continued disparities in maternal health.
KEY PROVISIONS
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high
Creates a special enrollment period for pregnant individuals on health insurance Exchanges (such as Healthcare.gov), beginning when the pregnancy is reported.
Ensures pregnant individuals can get health coverage through the ACA marketplaces as soon as they report their pregnancy, avoiding delays in care.
high
Establishes a special enrollment period for pregnant individuals directly with health insurance issuers in the individual market, beginning when the pregnancy is reported.
Allows pregnant individuals to enroll in new or updated health plans directly from insurance companies outside of the Exchanges, improving access to coverage options.
high
Mandates a special enrollment period for pregnant individuals within employer-sponsored group health plans, beginning when the pregnancy is reported or confirmed by a healthcare provider.
Ensures employees and their eligible dependents can get coverage for pregnancy through workplace plans immediately upon pregnancy, regardless of the regular enrollment schedule.
med
Requires the Secretary to issue regulations establishing a time period for pregnant individuals to enroll under employer-sponsored plans once the special enrollment period begins.
Provides clarity and consistency for how long pregnant individuals have to enroll after they become eligible for this new special enrollment period.
The Secretary shall promulgate regulations establishing a time period for pregnant individuals to enroll under employer-sponsored group health plans.
GLOSSARY
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Special Enrollment Period
A specific time outside of the yearly open enrollment period when certain people can sign up for health insurance due to major life events like marriage, having a baby, or losing other coverage.
Public Health Service Act
A major federal law that governs many public health programs and includes provisions related to health insurance and healthcare services.
Patient Protection and Affordable Care Act (ACA)
A comprehensive federal law passed in 2010 that expanded health insurance coverage and made significant changes to the healthcare system, including creating health insurance marketplaces.
Health Insurance Exchange
Online marketplaces (like Healthcare.gov) where individuals and small businesses can compare and enroll in health insurance plans that meet ACA requirements.
Group Health Plan
A health insurance plan provided by an employer or employee organization to its employees and their families.
Health Insurance Issuer
A company that sells health insurance policies directly to individuals or groups.
Maternal Mortality
The death of a woman during pregnancy or within one year after the end of pregnancy from any cause related to or aggravated by the pregnancy or its management.
ACTION TIMELINE
2 EVENTS
NOV 20, 25
Introduced in Senate
INTROREFERRAL
NOV 20, 25
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
A set of 10 categories of services that health insurance plans covered under the ACA must provide, including maternity and newborn care, prescription drugs, and mental health services.
