2020 NYS Health Plan Mandates

New York State has added mandates applicable to Health Insurance plans starting in 2020. These changes affect out-of-pocket maximums, mental health benefits, substance abuse benefits and fertility services covered in a health plan. Consumers should review their plan to determine how these mandates might effect them or their dependents. We recommend reaching out to your broker or insurance carrier directly with specific questions.

The Out-of-Pocket Maximum expense, meaning the most you have to pay for co-pay, deductible, or co-insurance costs, increases from $7,900 to $8,150 in 2020. This change doesn’t effect all plans since you are allowed to have lower out-of-pocket limits. Each insurance plan’s Summary of Benefits and Coverage (SBC) will list the Out-of-Pocket Maximum for each plan. We previously reported on the IRS press release noting increases in Health Savings Account (HSA) deductible levels and maximum annual contribution amounts.

Mental Health, substance abuse and autism services no longer require pre-authorization from your insurance carrier. Additionally, the primary care cost share must be applied to all outpatient services related to these diagnoses. Limits on the number of hours of services have also been removed.

Age restrictions have been removed for Fertility Preservation. Non-discrimination rules apply based on quality of life, disability, medical dependency, health conditions, and personal characteristics. Lastly, both men and women will be covered for treatments that may cause iatrogenic infertility (when a medical treatment can cause infertility).

These mandates will not affect he majority of enrollees, but for those that it does these are significant. As always, if you have question about your plan or coverages feel free to contact us to review your benefit plan.