Abortion and abortion related care coverage
Under the Reproductive and Gender-Affirming Care Act (Chapter 127 of the Acts of 2022, herein the “Act”), insurance carriers must cover all abortion and abortion-related care services for persons covered under a fully insured Massachusetts-based health plan, including subscribers, spouses, and any covered dependents on or after January 1, 2023.1
For the purposes of the Act, “abortion” is defined as “any medical treatment intended to induce the termination of, or to terminate, a clinically diagnosable pregnancy except for the purpose of producing a live birth; provided, however, that “abortion” shall not include providing care related to a miscarriage.”
Abortion-related care includes the following abortion-related services when they are provided in conjunction with a payable abortion procedure:
- pre-operative evaluation and examination,
- pre-operative counseling,
- laboratory services, including pregnancy testing, blood type, and Rh factor,
- Rh (D) immune globulin (human),
- anesthesia (general or local),
- post-operative care,
- follow-up, and
- advice on contraception or referral to family planning services.
Ultrasounds, pre-abortion evaluation and examination, and post-abortion care provided in conjunction with a covered surgical or medication-based abortion are also considered to be abortion-related care.
Coverage for these services may be subject to plan network and utilization review requirements. Benefits shall not be subject to any deductible, coinsurance, copayment, or other cost-sharing requirements, except with respect to a High-Deductible Health Plan. Please refer to your certificate of coverage for plan-specific information.
If you have any questions, please call the member phone number listed on your health plan ID card.