New insurance requirements big benefit to babies and families

Washington, state Insurance Commissioner Mike Kreidler announced this week that artificial insemination and providing human milk to babies whose parent can’t produce sufficient breast milk in a hospital setting are essential benefits for state residents. That means they must be covered by employee insurance plans, a step forward for babies and families.

“These benefits could be necessary for parents, or prospective parents, and are important coverages to add to our health plans,” Kreidler said in a release on October 25. “My office has worked hard to strengthen health insurance coverage and to the people who will need them, these will be crucial changes.”

What are essential benefits?

According to Kreidler’s office, the federal Affordable Care Act requires individual and small group health plans to cover a set of essential health benefits. The 10 federally mandated benefits are:

1. Ambulatory patient services: Covers outpatient care without being admitted to a hospital
2. Emergency medical services in an emergency department: Covers services provided in an emergency department if a medical provider believes the patient is having an emergency.
3. Hospitalization: Surgery and overnight stays.
4. Maternity and newborn care: Coverage for maternity and newborn health care.
5. Mental health substance abuse disorder services: Behavioral treatment, mental and behavioral health inpatient services and substance abuse disorder treatment.
6. Lab services: Such as blood draws or urinalysis, a medical provider orders.
7. Pediatric services: Health care for children from birth to age 19, including dental and vision care.
8. Prescription drugs: Medications a medical provider prescribes that patients buy through a pharmacy.
9. Preventive and wellness services and chronic disease management: Preventive services, such as shots and screening tests, at no cost to the patient when a medical provider from the plan’s network delivers the service.
10. Rehabilitative and habilitative services and devices: Services and devices to gain or recover mental and physical skills for people with injuries, disabilities or chronic conditions.

But states are allowed add benefits to their state benchmark plan. To do so they must submit an application to the Federal Centers for Medicare & Medicaid Services (CMS). Kreidler’s office got notice that its newest additions were approval by CMS earlier this month. The changes take effect in plan years starting on or after January 1, 2026.

New benefits

The following benefits will be added to the ten mentioned above and could have significant impact on kids and families and include:

• Coverage for human milk for inpatient use, when an infant is unable to receive maternal milk or when the parent is unable to produce maternal milk in sufficient quantities or caloric density.
• Coverage for hearing exams, or hearing aids in each ear, every three years.
• Coverage for artificial insemination in vivo, a fertilization treatment in which fertilization occurs internally as opposed to externally and in a lab.

Kreider’s office also announced that in their review of benefits for Washington residents, some were revised to ensure plans do not discriminate based on disabilities or health conditions.

Read more:

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