Bill
H 3249
SC H3249 requires state-regulated insurers to cover maternity care for dependents up to 26, matching primary coverage with no extra premiums, expanding access and protections.
Status snapshot
- Bill number: H 3249
- Title as filed: South Carolina Dependent Maternity Coverage Act
- Statutory placement: adds Section 38‑71‑142 to Article 5, Chapter 71, Title 38, S.C. Code
- Prefiled: 12/05/2024; introduced 01/14/2025; sponsors and referrals updated through 02/27/2025. Hearing scheduled 10/28/2025.
- Note: The bill text specifies it applies “to the extent not preempted by federal law.”
Purpose
- To require health insurers that provide dependent coverage up to age 26 to also provide maternity care coverage for those dependents, increasing access to prenatal, delivery, and postpartum services.
Key provisions
- Definitions:
- “Health insurer” — authorized insurers offering health policies, HMOs, and employer-based plans subject to state regulation.
- “Dependent” — an individual up to age 26 covered as a dependent of the primary policyholder.
- “Maternity care” — services during pregnancy, childbirth, and postpartum (prenatal care, labor/delivery, postpartum care, related labs/imaging, hospital stays).
- Coverage requirement:
- All state‑regulated insurers that cover dependents up to age 26 must include comprehensive maternity care for those dependents.
- Coverage must be consistent with the level provided to the primary policyholder and available across the insurer’s network.
- Services explicitly include routine prenatal visits, necessary labs/imaging, labor and delivery, childbirth‑related hospital stays, and postpartum visits/support.
- Cost-sharing restrictions:
- Insurers may not impose additional premiums, copays, or deductibles specifically for dependent maternity coverage beyond standard cost‑sharing applicable to other covered services.
- Exceptions and limits:
- Does not apply to plans preempted by federal law (e.g., self‑insured employer plans governed by ERISA).
- Religiously affiliated insurers may seek an exemption if coverage conflicts with their religious beliefs.
- Enforcement and reporting:
- South Carolina Department of Insurance responsible for compliance, complaint handling, and enforcement (fines/sanctions possible).
- Denied claims found to violate the statute must be processed and paid.
- The Department must submit an annual implementation report to the General Assembly.
- Effective date:
- January 1 following the year the act is approved by the Governor.
Who would be affected
- Directly affected: state‑regulated health insurers, dependents up to age 26 enrolled under those policies, and the families/policyholders who cover them.
- Indirectly affected: health care providers (maternity/prenatal/postpartum), insurers’ premium-setting and plan design processes, and employers that purchase fully insured plans in South Carolina.
- Not covered: self‑insured ERISA plans (federal preemption), unless otherwise subject to state regulation.
Potential impacts and considerations
- Expands access to maternity services for dependents aged ≤26 under state‑regulated plans.
- Could increase costs for insurers offering dependent coverage; cost impacts may be reflected in premiums for fully insured plans.
- Enforcement, religious exemptions, and ERISA preemption create boundaries on the law’s scope and applicability.
- Implementation details (e.g., complaint processes, penalty schedules) are delegated to the Department of Insurance.
Compiled from official sources — confirm details with the bill’s official record.
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