Gender Rating for Women’s Health Insurance

by Michele Postler, Wednesday, January 23, 2013

Apparently there is a tax out there called “woman tax”, and its been showing up on things like dry cleaning, deodorant, and goods that are imported because they are sold to women. But more importantly it has also been showing up in health care costs. The insurers’ reasoning is that women use health services more than men so they should be paying more for it. But how much is health insurance costs for women really different?

Individual Plan Ratings and Maternity Coverage

Research done by the National Women’s Law Center has provided a report that states that 92% of the top rated insurance companies charge women more for health insurance. This doesn’t even take into consideration maternity coverage because 25 states don’t even offer individual policies for maternity care. Of the nine states that do provide maternity coverage, insurers can deny a woman maternity insurance if she has previously had a Caesarian Section because they deem this a pre-existing condition. In the states that do offer insurance for maternity coverage the prices are usually unmanageable and can include a deductible up to $10,000, when the price of a normal delivery is on average $9,600. It can also include a waiting period of up to a year in some cases.

Group Plan Ratings

Gender rating is also abundant for group health care plans. If a company has predominantly female workers then the plans will cost the employer more on average than if there were more males working in the company. Laws that prohibit sex discrimination in the work place state that an employer can not charge male and female employees different rates for insurance coverage but this is not the same for the insurance companies. They will charge the employer more for more women in the company and this amount has to be spread evenly through out its employees so everyone is paying more. This practice doesn’t help the employer or the employee.

ACA and Revised Rating Restrictions

The new Affordable Care Act will revise the rate restrictions imposed by insurance companies to dissipate gender rating as well as industry rating and durational rating. They will also require all companies to cover what they determine as Essential Health Benefits. This will include benefits like maternity care as well as preventative and wellness services, including contraception.

The current rating definitions that insurance companies use to price a health insurance policy are:

Health status rating – takes into consideration the individuals previous medical conditions and any current medical conditions that make them a higher risk to the insurance companies.
Demographic rating – rates people based on their age, gender and where they live.
Industry rating – which rates an individual based on their occupation as well as what type of industry they work in.
Durational rating – raise premiums based on when the plan was originally taken.

In January 2014, the ACA will impose restrictions on the ratings that insurance companies can take into consideration and indicates that insurance companies may only adjust premiums based on the following: if the policy is for an individual or a family, the geographic area that the policy is taken, the age of the individual and if the individual uses tobacco or not.