Arthritis Foundation Legislative Position Statements

Arthritis Foundation Position Statement on Prohibiting Negative Health Insurance Plan Changes During a Contract Year

Issue

When selecting a health insurance plan, many people with chronic conditions make their decision after carefully weighing a complex variety of factors, including plan cost, medication formulary costs, cost sharing, the availability of specialists and the choice of hospitals.

Background

Insurance plans sometimes change the available benefits of a policy and coverage of medications, imposing new utilization management practices, increasing cost sharing obligations and making other changes that can have a negative impact on an insured. An insurer unilaterally changing its coverage while requiring an insured to stay in the plan is tantamount to a “bait and switch” technique and is adverse to the interests of people with arthritis.

Arthritis Foundation Position

The Arthritis Foundation supports legislation that keeps insurance coverage consistent and affordable during a plan year and provides the following:

  • Allowance for health insurance plans to increase benefits, coverage or access during a plan year. 
  • Restrictions that prohibit unfair trade practices—preventing health insurance plans from making changes to benefits, coverage, utilization management or access during a plan year that result in a negative impact on an insured.

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