Number of states mandating insurance

ne of the fastest growing areas of regulation in the health care sector is state-mandated benefits for private insurance plans.These are state laws that prescribe the content of health insurance purchased from Blue Cross/Blue Shield and commercial insurers.Contraception is crucial for helping women to avoid unintended pregnancies, and it has myriad health, social and economic benefits for women and families.

number of states mandating insurance-60

Mandated benefits often apply to the coverage of particular providers, such as chiropractors and psychologists, the coverage of services, such as alcohol and drug abuse treatment, and the coverage of types of individuals, such as children with disabilities and terminated workers.

This article briefly describes the scope of those regulations, considers why they exist, summarizes what we know about their effects in insurance markets, and finally, raises some policy questions regarding the regulations.

Covered treatment includes medically necessary pharmacy care, psychiatric care, psychological care, habilitative or rehabilitative care, and therapeutic care (which includes services provided by a licensed speech-language pathologist.) There is no limit on the number of visits an individual may make to an autism services provider. However, behavioral therapy is specifically defined as applied behavioral analysis and coverage limitations for behavioral therapy are set out.

§20-826.04; §20-1057.11; §20-1402.03; §20-1404.03 Requires health benefit plans issues or renewed on or after October 1, 2011 to provide for coverage for the diagnosis and treatment of autism spectrum disorder. §23-99-418 [PDF] (as created by HB 1315 [2011]) Requires all health care service plan contract that provides hospital, medical, or surgical coverage to provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. Treatments include: evaluation and assessment services; Behavior training and behavior management and applied behavior analysis; habilitative or rehabilitative care, including, but not limited to, occupational therapy, physical therapy, or speech therapy, or any combination of those therapies; pharmacy care and medication; psychiatric care; psychological care; and therapeutic care, including, but is not limited to, speech, occupational, and applied behavior analytic and physical therapies. However, behavioral therapy is specifically defined as applied behavioral analysis and coverage limitations for behavioral therapy are set out.

States, however, continue to pass new mandates, but with a twist: Now they’re adding language to sidestep the health law, making it tougher than ever for consumers to know whether they’re covered or not. They may require coverage of broad categories of benefits, such as emergency services or maternity care, or of very specific benefits such as autism services, infertility treatment or cleft palate care.

Some mandates require that certain types of providers’ services be covered, such as chiropractors.

Since the health law established a comprehensive set of “essential health benefits” that individual and small group plans must cover (unless they existed prior to passage of the law in 2010), it was hoped that mandates would no longer be much in demand, says Sabrina Corlette, project director at Georgetown University’s Center On Health Insurance Reforms.

Mandates are “not the most rational way to build a benefit package,” says Corlette.

To discourage states from passing mandates that go beyond essential health benefits requirements, the law requires states, not insurers, to cover the cost of mandates passed after 2011 that apply to individual and small group plans sold on or off the state health insurance marketplaces.

If a mandate increases a plan’s premium, states will be on the hook for the additional premium cost that’s attributable to the mandate.

Coverage under this section shall not be denied on the basis that the treatment is habilitative or nonrestorative in nature. Coverage for benefits for any covered person diagnosed with one or more autism spectrum disorders and whose age is at least seven years and less than 19 years shall not exceed ,000 per year. Coverage for autism spectrum disorders shall be subject to

Some mandates require that certain types of providers’ services be covered, such as chiropractors.Since the health law established a comprehensive set of “essential health benefits” that individual and small group plans must cover (unless they existed prior to passage of the law in 2010), it was hoped that mandates would no longer be much in demand, says Sabrina Corlette, project director at Georgetown University’s Center On Health Insurance Reforms.Mandates are “not the most rational way to build a benefit package,” says Corlette.To discourage states from passing mandates that go beyond essential health benefits requirements, the law requires states, not insurers, to cover the cost of mandates passed after 2011 that apply to individual and small group plans sold on or off the state health insurance marketplaces.If a mandate increases a plan’s premium, states will be on the hook for the additional premium cost that’s attributable to the mandate. Coverage under this section shall not be denied on the basis that the treatment is habilitative or nonrestorative in nature. Coverage for benefits for any covered person diagnosed with one or more autism spectrum disorders and whose age is at least seven years and less than 19 years shall not exceed $27,000 per year. Coverage for autism spectrum disorders shall be subject to $1,000 maximum benefit per month, per covered individual. Coverage shall be subject to a maximum benefit of $36,000 per year and a lifetime maximum benefit of $144,000.

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Some mandates require that certain types of providers’ services be covered, such as chiropractors.

Since the health law established a comprehensive set of “essential health benefits” that individual and small group plans must cover (unless they existed prior to passage of the law in 2010), it was hoped that mandates would no longer be much in demand, says Sabrina Corlette, project director at Georgetown University’s Center On Health Insurance Reforms.

Mandates are “not the most rational way to build a benefit package,” says Corlette.

To discourage states from passing mandates that go beyond essential health benefits requirements, the law requires states, not insurers, to cover the cost of mandates passed after 2011 that apply to individual and small group plans sold on or off the state health insurance marketplaces.

If a mandate increases a plan’s premium, states will be on the hook for the additional premium cost that’s attributable to the mandate.

Coverage under this section shall not be denied on the basis that the treatment is habilitative or nonrestorative in nature. Coverage for benefits for any covered person diagnosed with one or more autism spectrum disorders and whose age is at least seven years and less than 19 years shall not exceed $27,000 per year. Coverage for autism spectrum disorders shall be subject to $1,000 maximum benefit per month, per covered individual. Coverage shall be subject to a maximum benefit of $36,000 per year and a lifetime maximum benefit of $144,000.

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Some mandates require that certain types of providers’ services be covered, such as chiropractors.

Since the health law established a comprehensive set of “essential health benefits” that individual and small group plans must cover (unless they existed prior to passage of the law in 2010), it was hoped that mandates would no longer be much in demand, says Sabrina Corlette, project director at Georgetown University’s Center On Health Insurance Reforms.

Mandates are “not the most rational way to build a benefit package,” says Corlette.

To discourage states from passing mandates that go beyond essential health benefits requirements, the law requires states, not insurers, to cover the cost of mandates passed after 2011 that apply to individual and small group plans sold on or off the state health insurance marketplaces.

,000 maximum benefit per month, per covered individual. Coverage shall be subject to a maximum benefit of ,000 per year and a lifetime maximum benefit of 4,000.

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