On February 12, 2025, the Massachusetts Division of Insurance issued frequently asked questions (FAQs)-style guidance regarding a 2022 law known as the Act Expanding Protections for Reproductive and Gender Affirming Care. The FAQs are intended to help insurance companies, employers, providers, pharmacists, and individual plan participants understand the reproductive access rights provided under the law and other related state laws and insurance bulletins.
The new guidance clarifies that most Massachusetts residents enrolled in fully insured group or individual health insurance plans have coverage for abortion and abortion-related care without the application of cost sharing, whether the coverage was issued in Massachusetts or outside Massachusetts. For coverage issued by Blue Cross and Blue Shield of Massachusetts or by a health maintenance organization, Massachusetts residents are covered for abortion and abortion-related care only when their coverage is issued in the commonwealth. Individuals who are covered by self-insured group health plans are not subject to these coverage requirements. The FAQs direct people to ask their employers if their group health plan is fully insured and required to follow Massachusetts law regarding coverage of abortion services.
The FAQs also address limited circumstances when individuals in fully insured plans might not have benefits covering abortions or abortion-related services. People covered by a health maintenance organization may not have coverage if they receive non-emergency abortion-related care from an out-of-network healthcare provider. Also, organizations that qualify as a church or a qualified church-controlled organization according to Massachusetts law may request that their insurance carrier provide them and their employees with coverage that does not include abortion or abortion-related care. However, any employer that invokes this exemption must provide written notice to eligible individuals prior to enrollment. Such notice must list the healthcare methods and services the employer will not cover for religious reasons. Further, the insurance carrier is expected to clearly disclose when a plan does not cover abortion services.
While the law requires in-network abortion and abortion related coverage to be provided without cost-sharing, the guidance clarifies that if the coverage is offered through a federally qualified HDHP with an HSA, these services may be subject to the deductible to preserve the plan’s qualified status.
Finally, the guidance explains earlier related Massachusetts policy measures. A 2017 law mandates coverage of emergency contraception for consumers with fully insured health insurance coverage in Massachusetts. Further, two existing Insurance Division bulletins require insurance carriers to protect the privacy of individuals who receive abortion or abortion-related services. Insurers must exclude the identification of sensitive healthcare services, including abortion-related care services, from any health plan member’s summary of payments. Individuals or their authorized representatives may also request that their insurer suppress their summary of payments.
Massachusetts employers may find these FAQs to be useful when addressing employee questions about abortion or abortion-related coverage. Further, it explains which types of fully insured insurance group coverage issued in another state are subject to the terms of the coverage mandate, and it provides details about the notice requirements for employers who access the mandate’s religious exemption.
Frequently Asked Questions About Abortion and Abortion Related Care