Protecting Confidentiality for Individuals Insured as Dependents

Background

Background

Billing and claims processing procedures widely used in private health insurance routinely, albeit inadvertently, prevent anyone insured as a dependent on someone else’s policy from obtaining sensitive services confidentially. One of the most frequent ways in which disclosure occurs is through explanation of benefits forms (EOBs) sent by insurers to policyholders after anyone covered under their policy obtains care. EOBs—which typically identify the individual who received care, the health care provider and the type of care obtained—essentially make it impossible for dependents, often minors and young adults, to obtain the confidential access to sexual and reproductive health care they need.

Several states have developed creative approaches to address these as well as broader confidentiality concerns—solutions that satisfy the needs of insurers, protect policyholders from unexpected financial exposure and, most importantly, facilitate access to confidential care for all covered individuals.

Visit our state legislation tracker for policy activity on all sexual and reproductive health topics.

Highlights

  • 14 states have provisions that serve to protect the confidentiality of individuals insured as dependents.
    • 6 states allow individuals insured as dependents to request confidential communications from their insurance provider via a written request.
    • 4 states have confidentiality protections specific to EOBs. These states allow insurers to mail an EOB directly to the patient instead of the policy holder. Insurance providers in New York and Wisconsin are not required to send an EOB to the policyholder if there is no balance due.
    • 6 states explicitly protect the confidentiality of minors insured as dependents.
      • 4 states have specific protections for minors seeking STI treatment.
      • 3 states have protections for minors seeking any medical service.
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Protecting Confidentiality for Insured Dependents

STATE

STATE EXPLICITLY REQUIRES INSURER TO PROVIDE CONFIDENTIAL COMMUNICATIONS UPON WRITTEN REQUEST OF INSURED DEPENDENT

PROTECTIONS SPECIFIC TO EOBs

PROTECTIONS FOR MINOR DEPENDENTS

 

Confidentiality for STI Treatment

Broader Confidentiality Provisions

California

X

 

 

 

Colorado

X

 

 

 

Connecticut

 

 

X

 

Delaware

 

 

X

 

Florida

 

 

X

 

Hawaii

 

 

 

Health care provider must inform insurer when "minors without support" request confidentiality

Illinois

 

 

 

Maine

 

 

 

Minor may refuse parents' request for EOB or claim denial

Maryland

X

 

 

 

Massachusetts

X

X    

New York

 

X

 

 

Oregon

X

 

 

 

Washington

XΩ​

 X

 X

Insurer may not disclose private health information, including through an EOB, without minor's authorization

Wisconsin

 

X

 

 

TOTAL

6

4

4

3

*   An insurer may grant requests for sensitive services or for services whose disclosure may endanger the dependent. †   Applies only to adult dependents. Ω  For adult dependents, applies to sensitive services or to all services if the patient has specified a particular person who may not receive information. For minors, applies to all services unless minor has authorized that information may be disclosed. ‡   Illinois protections only apply to sensitive services provided to Medicaid participants.