Benefits Mandates

VII. Key Issues: Regulation & Reform >> B. Health Care Regulation >> Health Insurance Regulation >> Benefits Mandates

 

Overview

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 MHPA was largely superseded by the Mental Health Parity and Addiction Equity Act (MHPAEA), signed into law by President George W. Bush in October 2008.
  • Newborns’ and Mothers’ Protection Health ActThe 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.

 

General Analysis

  • 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 PremiumsEastern 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