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Mandated Benefits - Understanding Mandated Health Insurance Benefits

what is mandated employer insurance

By Michael Bihari, MD. Health Insurance Expert

Updated December 29, 2014.

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Although mandates continue to be added as health insurance requirements, they are controversial. Patient advocates claim that mandates help to ensure adequate health insurance protection while others (especially health insurance companies) complain that mandates increase the cost of healthcare and health insurance.

Mandated Health Insurance Benefit Laws

Mandated health insurance laws passed at either the federal or state level usually fall into one of three categories:

  • Healthcare providers other than physicians, such as acupuncturists. chiropractors, nurse midwives, occupational therapists. and social workers.
  • Dependents and other related individuals, such as adopted children, dependent students, grandchildren, and domestic partners .

The mandated benefit laws most often apply to health insurance coverage offered by employers and private health insurance purchased directly by an individual.

Mandated Insurance Benefits and the Cost of Health Insurance

Most people – whether for or against mandates – agree that mandated health benefits increase health insurance premiums .

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Depending on the mandated benefit and how that benefit is defined, the increase cost of a monthly premium can increase from less than 1% to more than 5%.

Trying to figure out how a mandated benefit

will impact an insurance premium is very complicated. The mandate laws differ from state to state and even for the same mandate, the rules and regulations may vary.

For example: Most states mandate coverage for chiropractors, but the number of allowed visits may vary from state to state. One state may limit the number of chiropractor visits to four each year, while another state may allow up to 12 chiropractor visits each year. Since chiropractor services can be expensive, the impact on health insurance premiums may be greater in the state with the more generous benefit.

Additionally, the lack of mandates could also increase the cost of healthcare and health insurance premiums. If someone who has a medical problem goes without necessary health care because it is not covered by her insurance, she may become sicker and need more expensive services in the future.

Federal Mandated Health Benefits

Federal law includes a number of insurance-related mandates.

COBRA provides certain former employees and their dependents the right to continue coverage for a maximum of 18 to 36 months.

Coverage of adoptive children

Certain health plans must provide coverage to children placed with families for adoption under the same conditions that apply to natural children, whether the adoption has become final or not.

Category: Insurance

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