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Filed Under:Health Insurance, Ltci

Group challenges gender-based LTCI rates

The courts

(Thinkstock image)
(Thinkstock image)

A nonprofit legal organization says charging women more for private long-term care insurance (LTCI) violates Section 1557 of the Patient Protection and Affordable Care Act (PPACA).

The National Women's Law Center has filed complaints making that case with the Office for Civil Rights at the U.S. Department of Health and Human Services (HHS).

Insurers have argued that women tend to have much higher long-term care (LTC) claims than men, and that increasing the cost of coverage for women who buy LTCI policies on their own may help them hold down the cost of coverage for men.

Insurers also have argued that LTCI coverage is different from major medical insurance and is exempt from the PPACA provisions that set standards for major medical policies.

The women's law center argues in the complaints, which name units of four different insurance organizations as targets, that charging women more for LTCI coverage simply because they are women is "sex discrimination, plain and simple."

PPACA Section 1557 states that an individual shall not "be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an executive agency or any entity established under this title (or amendments)."

LTCI programs benefit state "partnership" programs that coordinate Medicaid nursing home benefits with private LTCI benefits, the law center says.

The center is asking the HHS Office of Civil Rights to eliminate gender-based LTCI pricing and to end LTCI partnership program support for carriers that use gender-based LTCI premiums.

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