For Consumers

Women's health insurance rights

 Important: Starting Jan. 1, 2024, Washington state-regulated health plans must cover medically necessary diagnostic and supplemental breast exams with no out-of-pocket costs for the covered patient. This includes exams using breast magnetic resonance imaging or breast ultrasound  (leg.wa.gov)

Under state law (leg.wa.gov), health insurance companies must give female patients direct access to women's health care providers and to allow them to self-refer to services, such as:

Women’s health care providers include:

  • Licensed specialty doctors, such as gynecologists and obstetricians.
  • Licensed physician assistants or registered nurse practitioners specializing in women's health and midwifery.

Your health insurance company must allow you to:

  • Choose a participating women's health care provider from its network provider list.
  • Self-refer to a network provider to receive women's health care services.

Health reform for women's health services

Due to health reform, most health plans must cover a list of preventive health services for women (www.healthcare.gov), such as:

  • Breastfeeding supplies
  • Counseling for sexually transmitted infections
  • Domestic violence screening
  • Gestational diabetes screening
  • HPV (human Papillomavirus) testing
  • Mammograms
  • Prescription contraceptives
  • Well-woman visits (including routine breast and pelvic exams)

In addition, if you receive these preventive services from a network provider for an individual or small group plan, you won't be charged a copayment, coinsurance, or have the charges applied to your annual deductible.