VII. Key Issues: Regulation & Reform >> B. Health Care Regulation >> Health Insurance Regulation >> Benefits Mandates
This includes mandated standards of care and other mandated health services imposed by states and the federal government, including:
- Mental Health Parity Act (MHPA: 1996)
- Mental Health Parity and Addiction Equity Act (MHPAEA: 2008)
- Newborns’ and Mothers’ Protection Health Act (1996)
- Women’s Health and Cancer Rights Act (WHCRA: 1998)
The Duke Center for Health Policy and Inequalities Research has developed a draft working paper on the benefits and costs of mandated health benefits: (pdf)
Specific Benefits Mandates
- Maternity Benefits. Under the 1978 Pregnancy Discrimination Act, employers with 15 or more workers must offer maternity coverage. Some states have tighter regulations, including 12 states that mandate maternity coverage in the individual market and 17 that require it in the small-group market. See also Maternity Coverage in the Individual Health Insurance Market (House Energy and Commerce Committee, 10.12.2010).
- Mental Health Parity Act. The Mental Health Parity Act of 1996 was effective from January 1, 1998-September 30, 2001 (The original sunset provision (providing that the parity requirements would not apply to benefits for services furnished on or after September 30, 2001) was extended six times through 2007). The law did not mandate that any employers provide mental health coverage but for employers that already offered such coverage, the law in various ways made mental health benefits more comparable to benefits related to physical health. MHPA was largely superseded by the Mental Health Parity and Addiction Equity Act (MHPAEA), signed into law by President George W. Bush in October 2008.
- See 2012 Report to Congress: Compliance With the Mental Health Parity and Addiction Equity Act of 2008.
- Department of Labor. Mental Health Parity. Includes links to fact sheets and interim and final regulations.
- Newborns’ and Mothers’ Protection Health Act. The law was signed into law on September 26, 1996, requiring plans that offer maternity coverage to pay for at least a 48-hour hospital stay following childbirth (96-hour stay in the case of a cesarean section). This law was effective for group health plans for plan years beginning on or after January 1, 1998.
- Women’s Health and Cancer Rights Act. Under WHCRA, group health plans, insurance companies and health maintenance organizations (HMOs) offering mastectomy coverage also must provide coverage for certain services relating to the mastectomy in a manner determined in consultation with your attending physician and you. This required coverage includes all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses and treatment of physical complications of the mastectomy, including lymphedema.
- California Health Benefits Review Program. Health Insurance Benefit Mandates in California State and Federal Law (Oakland:University of California, 2012).
- Bailey, James. The Effect of Health Insurance Benefit Mandates on Premiums. Eastern Economic Journal, 2013, (1–9). This paper examines the effects of laws mandating that health insurance cover specific conditions, procedures, providers, and beneficiaries. Unlike previous work, this paper considers the market for employer-based health insurance rather than the much smaller individual market, and uses a panel data approach to account for unobserved heterogeneity among states. Using a fixed effects model, I find that the average mandate increases premiums by 0.44–1.11 percent annually. This implies that new mandates were responsible for 9–23 percent of all premium increases over the 1996–2011 period.
Analysis of Specific Mandates
- Mandated Health Benefits Evaluation Reports (Massachusetts)
- Review and Evaluation of Proposed Legislation Entitled: An Act Relative to Establishing the Mass. Childhood Vaccine Program and the Mass. Immunization Registry Senate Bill 2195 House Bill 3453 (PDF) | Word
- Review and Evaluation of Proposed Legislation Entitled: An Act to Provide Coverage for Hearing Aids House Bill 3598 (PDF) | Word
- Review and Evaluation of Proposed Legislation Entitled: An Act Relative to Insurance Coverage for Autism (PDF) | Word
- Review and Evaluation of Senate Bill 485: An Act Relative to Increasing Coverage for Infertility Treatments (August 2009) (PDF) | Word
- Review and Evaluation of House Bill 4557: An Act Relative to Coverage for Cleft Palate and Cleft Lip (May 2009) (PDF) | Word
- Paper Related to Senate Bill 433: An Act Regarding Continuity of Prescription Drug Coverage (May 2009) (PDF) | Word
- Review and Evaluation of House Bill 2058: An Act Relative to Urea Cycle Disorders (May 2009) (PDF) | Word
- Review and Evaluation of House Bill 3931: An Act Relative to Providing for Insurance Coverage for Vision Screening for Children (May 2009) (PDF) | Word
- Review and Evaluation of Senate Bill 564: An Act Relative to Coverage for Prescription Drug Voice Synthesizers (May 2009) (PDF) | Word
- Children’s Mental Health (July 2008) (PDF) | Word
- Comprehensive Review of Mandated Benefits in Massachusetts (July 2008) (PDF) | Word
- Mental Health Parity (July 2008) (PDF) | Word
- Eating Disorders (October 2007) (PDF) | Word
- Educational Psychologists (August 2005) (PDF) | Report only (Word)
- Certain Prosthetic Devices (April 2005) (PDF) | Word
- Ectodermal Dysplasia (March 2005) (PDF) | Report only (Word)
- Marriage and Family Therapists (January 2005) (PDF) | Word
- Chiropractic Services (January 2005) (PDF) | Word