Mid-Year Plan Changes
Learn more about our advocacy position on the issue of mid-year insurance plan changes, including the solutions we endorse and current legislative trends.
- When selecting a health plan, many people with chronic conditions make their decisions after carefully weighing a complex variety of factors, including plan cost, network adequacy, medication formulary adequacy, cost sharing, the availability of specialists, and the choice of hospitals.
- Insurance plans sometimes change the available benefits of a policy and coverage of medications during the plan year, imposing new requirements, increasing cost sharing obligations, and making other changes that can disrupt the treatment of stable patients.
- Without a major life event, a plan member may not be able to access coverage that best meets his or her treatment needs.
- An insurance provider (insurer) unilaterally changing its coverage while requiring insured members to stay in the plan is tantamount to a "bait and switch" technique which we believe is inherently unfair.
- Legislation that keeps insurance coverage consistent and affordable during a plan year by preventing health insurers from making changes to benefits, coverage, or access during a plan year that result in a negative impact on members of a plan.
- Advance notice of formulary changes that will occur during open enrollment.
To date, 4 (four) states have addressed formulary changes during a plan year through state legislation.
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