The office of General Counsel issued the following informal opinion on August 13, 2000, representing the position of the New York State Insurance Department.
Re: Health Insurance Coverage for Midwifery Services.
Question:
Do health insurers licensed in New York have to provide coverage for pregnancy and delivery services by a midwife?
Conclusion:
Health insurers licensed in New York must provide maternity care coverage, which includes prenatal, delivery and postnatal services, through a licensed midwife.
Facts:
No specific facts were provided.
Analysis:
New York Insurance Law §§ 3221 (k)(5)(A)(i) and 3221 (k)(5)(A)(ii) (McKinney 2000), in particular, provide mandatory maternity care coverage and state that:
(i) Every group or blanket policy delivered or issued for delivery in this state which provides hospital, surgical or medical coverage shall include coverage for maternity care, including hospital, surgical or medical care to the same extent that coverage is provided for illness or disease under the policy. Such maternity care coverage, other than coverage for perinatal complications, shall include inpatient hospital coverage for mother and newborn for at least forty-eight hours after childbirth for any delivery other than a caesarean section, and for at least ninety six-hours after a caesarean section. Such coverage for maternity care shall include the services of a midwife licensed pursuant to article one hundred forty of the education law, practicing consistent with a written agreement pursuant to section sixty-nine hundred fifty-one of the education law and affiliated or practicing in conjunction with a facility licensed pursuant to article twenty-eight of the public health law, but no insurer shall be required to pay for duplicative routine services actually provided by both a licensed midwife and physician. (Emphasis supplied)
(ii) maternity care coverage shall also include at a minimum, parent education, assistance and training in breast or bottle feeding, and the performance of any necessary maternal and newborn clinical assessments.
N. Y. Ins. Law §§ 3221 (k)(5)(A)(i), 3221(k)(5)(A)(ii) (McKinney 2000).
Furthermore the maternity care coverage provided by the insurer must include coverage for prenatal and postnatal care as follows:
(B) Coverage provided under this paragraph for care and treatment during pregnancy shall include provision for not less than two payments, at reasonable intervals and for services rendered, for prenatal care and a separate payment for the delivery and postnatal care provided.
N. Y. Ins. Law § 3221 (k)(5)(B) (McKinney 2000).
For further information you may contact Senior Attorney Adiza J. Mohammed at the New York City Office.