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Contraceptive Services Claims Restitution Information

Introduction

This webpage contains contact information and other details about the Contraceptive Services Claims Restitution payments, including what to do if you do not receive a refund but believe that one is owed to you.

Contraceptia clear vile bottle with a syringe next to it all superimposed on a light blue backgroundve Services Claims Restitution Announcement

Recently the three major insurance carriers serving Vermonters Blue Cross Blue Shield of Vermont, MVP Health Care, Cigna Healthcare – announced that refund checks will be distributed to all policy holders charged a member cost-share for contraceptive services guaranteed as no cost-share according to 8 V.S.A. § 4099c.

Under the Affordable Care Act (ACA), health insurance plans must provide coverage at no cost to consumers for contraceptive services and supplies, including the full range of birth control, counseling, treatment of complications, and any other related services. Birth control can include options such as an intrauterine device (IUD) insertion and removal, prescribed emergency contraception, birth control pills, and sterilization procedures such as tubal ligation. 

DFR investigated compliance with the mandate by auditing health insurance medical claims and identifying those with contraceptive-related medical services. While the Department found that BCBSVT, MVP and Cigna were noncompliant with laws prohibiting member cost-share for contraceptive services during the audit period - extended through December 31, 2021 - it found no intent on behalf of any carrier to violate the mandate. According to the Market Conduct team, all insurers were cooperative, responsive to requests and agreeable to working toward solutions with the team.

The Department discovered that many claims applied member cost-share for mandated services. The investigation revealed that these claims were incorrectly processed because of coding, differing interpretations of the mandate, and system limitations. The major categories of claims processed with cost share are as follows:

  • Sterilizations for women: miscellaneous ancillary services.
  • Pregnancy tests related to contraceptive services.
  • Contraceptive office visits.
  • Ultrasounds associated with contraceptive services: ultrasounds are frequently performed in conjunction with IUDs, often to ensure accurate placement, to detect complications associated with the IUD, or for removal procedures.
  • Sexually Transmitted Infection (STI) tests: physicians routinely test for STIs prior to performing contraceptive services or providing contraceptive prescriptions.
  • Sterilizations for men (Vermont-specific mandate).

The DFR Market Conduct unit investigation excluded contraceptive prescription drug claims. If you believe you were incorrectly charged a cost-share for a contraceptive prescription drug or device, please contact your health insurer or employee benefit specialist.

Member Support and Insurance Carrier Statements

  • Blue Cross Blue Shield of Vermont 
    “Blue Cross VT is committed to providing our members with contraceptive care with no out-of-pocket cost. The Department of Financial Regulation (DFR) recently provided additional guidance about coverage for contraceptive care. We are working to ensure that every member who paid a co-payment for these services since 2017 is reimbursed. We collaborated with DFR to proactively identify the individuals who are owed a refund. Our members who are identified will receive a check from Blue Cross VT at the earliest practicable date.” 
    Contact: BCBSVT Customer Service 800-247-2583 
    Monday - Friday • 7 am - 6 pm • Visit BCBSVT Contact Us.

  • Cigna
    “At Cigna Healthcare, we are proud to cover contraceptive care with no cost share for our Vermont customers. We appreciate the collaborative approach by the Department of Financial Regulation to ensure that all who were charged a cost-share in error for contraceptive coverage are paid back. Those customers do not need to take any action and will soon receive a check from Cigna Healthcare for the amount owed to them.”
    Contact: Call the number on the back of your insurance card or visit Cigna Contact Us.
     
  • MVP Health Care
    "MVP is committed to providing its members with vital, no-cost access to contraceptive services consistent with state and federal requirements. Affected members should receive a letter from MVP in the coming days with additional information on cost-share reimbursement.
    Contact: Both past and current MVP members may contact MVP’s Customer Care Center at 800-348-8515 (TTY 711).  
    Monday - Friday • 8 am–6 pm • Or complete the Customer Care Contact Form.

Note: This settlement affects only those individuals whose health insurance is provided by MVP Health Care, Cigna or Blue Cross Blue Shield of Vermont. Those covered by other insurers should contact their insurers or their employer’s benefits manager.

Background

In late 2021, the Department began an investigation into potential issues surrounding health insurance coverage for contraceptive services. Department staff audited contraceptive claims for all health plans subject to DFR’s jurisdiction and offered or administered by BCBSVT, MVP and Cigna. The claims were audited back to the effective date of the Vermont mandate, October 1, 2017, and through December 31, 2021. The Department reviewed more than 250,000 medical claims that included over 500,000 claim lines and found that cost-share was applied to 16,000-plus claims, leading to restitutions totaling more than $1.5 million owed to over 9,000 members.

Because Vermont law builds on the ACA – requiring health plans subject to State jurisdiction to cover voluntary sterilization for men (to the extent that it would not disqualify a high-deductible health plan from eligibility for a health savings account) and a 12-month supply of prescribed contraceptives without member cost-sharing – those health plans and health insurance issuers that require member cost-sharing for contraceptive services are out of compliance with both federal and state laws.

Corrective Actions: Following numerous meetings between the Department and insurance carriers, BCBSVT, MVP Health Care and Cigna have implemented or will implement several measures to correct these issues.

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