SSB 5075
In CommitteeSenate
Prenatal and postnatal care
Concerning cost sharing for prenatal and postnatal care.
- Introduced (completed)
- 2Committee (current stage)
- 3Floor Vote (not started)
- 4Opposite Chamber (not started)
- 5Governor (not started)
- 6Signed (not started)
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill prohibits most health plans that cover maternity services from charging patients out-of-pocket costs (like copays or deductibles) for prenatal and postnatal care services, starting in 2026. It includes a narrow exception for plans tied to health savings accounts to comply with federal tax rules.
- Starting January 1, 2026, health plans that cover maternity services must provide covered prenatal services (e.g., office visits, lab tests, ultrasounds, prescriptions, prenatal vitamins) with no copays, coinsurance, or deductibles.
- Postnatal services (e.g., office visits, lactation support, C-section follow-up, counseling, prescriptions) must also be provided with no cost-sharing.
- A limited exception allows health savings account (HSA)-eligible plans to set minimal cost-sharing only to the extent required to maintain their HSA-qualified status under federal tax rules.
- The law applies to health plans issued or renewed on or after January 1, 2026—including employer-sponsored, individual, and Medicaid-managed care plans.
Who is affected
- People with health insurance covering maternity services — People with employer-sponsored, individual, or Medicaid-managed care health plans that include maternity coverage—these plans must eliminate copays, coinsurance, and deductibles for covered prenatal and postnatal services starting in 2026.
- Pregnant individuals and new parents — Pregnant individuals and new parents who use covered services like office visits, ultrasounds, lab tests, prescription drugs, and postpartum counseling will no longer pay out-of-pocket for those services (with limited exceptions).
- Health insurance carriers — Health insurance companies and carriers must adjust their plan designs and billing systems to comply with the new no-cost-sharing requirement for maternity services.
- People with HSA-eligible health plans — People with high-deductible health plans (HDHPs) that are paired with health savings accounts (HSAs) may face special rules to ensure their plans still qualify as HSA-eligible while meeting the no-cost-sharing mandate.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (3)
Eliminating copays, coinsurance, and deductibles for prenatal and postnatal care removes financial barriers to essential healthcare, likely increasing the frequency of visits and improving health outcomes for pregnant individuals and new parents.
HealthcarePeopleRef: Sec. 1(1): '...may not impose any cost-sharing requirements for covered prenatal services... and covered postnatal services...'Pregnant individuals and new parents will save significant out-of-pocket expenses on routine visits, tests, and medications, providing direct financial relief to families during a period of high medical need.
FinancialPeopleRef: Sec. 1(1): '...including, but not limited to, office visits, laboratory services, ultrasons... and prescription drugs.'By covering postnatal counseling and therapy without cost-sharing, the bill addresses mental health needs during the postpartum period, which is critical for maternal well-being and family stability.
HealthcarePeopleRef: Sec. 1(1): '...covered postnatal services including... counseling and therapy services...'
Potential Concerns (2)
Insurers will likely pass the cost of eliminating cost-sharing for maternity care through higher premiums for all enrollees, including those who do not use maternity services, effectively shifting the financial burden to the general insured population.
FinancialLean industryRef: Sec. 1(1): '...costs would be absorbed by insurers and potentially passed through premiums.'The exception for Health Savings Account (HSA) plans allows these specific plans to maintain cost-sharing, which primarily benefits higher-income individuals who can afford high-deductible plans and utilize tax-advantaged HSAs, rather than providing universal relief.
FinancialLean industryRef: Sec. 1(2): '...health carrier shall establish the plan's cost sharing... at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions from their health savings account...'
Who Is Most Affected
- Pregnant individuals and new parentsPositive Impact
They will no longer pay out-of-pocket for covered prenatal and postnatal services, leading to improved access to care and reduced financial stress during pregnancy and early parenthood.
- Health insurance carriersNegative Impact
They must adjust plan designs and billing systems to comply with the new mandate, and they will likely face pressure to increase premiums to offset the loss of cost-sharing revenue from maternity care.
- Employers sponsoring health plansNegative Impact
As the primary payers for health insurance, they may see increased premium costs due to insurers passing through the costs of the new mandate, affecting their overall compensation packages.
- Individuals with HSA-eligible plansMixed Impact
They retain the ability to use tax-advantaged HSAs with their high-deductible plans, preserving a specific financial benefit that is not available to those in standard plans, though they still face some cost-sharing.