NY 1332 Waiver – Diabetic and Pregnant Members for QHP
Beginning January 1st, 2025, MetroPlusHealth’s Qualified Health Plan (QHP) members who report becoming pregnant, will have their cost-sharing for all services, apart from those outlined below, waived for the duration of the pregnancy and postpartum for up to one year (i.e. 12-months postpartum).
- Ambulance Services
- All Inpatient Services (hospital, rehabilitation, mental health, substance use disorder, hospice, skilled nursing facility, etc.)
- Emergency Services
- Physician, Nurse Practitioner, and Midwife Services for Delivery
- Inpatient Hospital and Birthing Center Services for Delivery
Additionally, cost-sharing will be waived for the following services for members whose primary diagnosis is Diabetes.
- Primary Care Visits
- Dilated Retinal Examination (once per year)
- Diabetic Foot Examination (once per year)
- Nutritional Counseling Visits
- Laboratory Tests (for the diagnosis and management of Diabetes)
- Diabetic Supplies
- Prescription Drugs (for the treatment of Diabetes)
This new policy change is part of New York’s 1332 Waiver, designed to reduce or eliminate cost-sharing for QHP members with Diabetes or those who are pregnant in the individual market. By lowering out-of-pocket costs, the initiative aims to improve access to recommended care, decrease the risk of unnecessary hospitalizations, and enhance overall health outcomes.
Please refrain from applying cost-sharing where appropriate and encourage members to report their pregnancy to the NYSOH Marketplace, if they have not already done so, to update their account accordingly. For more details on cost-sharing for these services, please visit our Marketplace QHP Plans and review the Certificate of Coverage for the applicable plan.
