Government mandating


10-Nov-2017 05:52

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COBRA continuation coverage 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.

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.

Some examples of additional state-specific benefit mandates are infertility coverage, autism coverage, and limiting out-of-pocket costs for prescriptions.

But there are rules that require states—rather than insurers—to cover the cost of benefit mandates that go beyond the ACA's requirements, which means that some states have opted to apply new mandates only to large group plans, which aren't subject to the ACA's essential health benefit requirements (note however, that self-insured plans are regulated under federal rules rather than state oversight, so they are not subject to new requirements that states impose; the majority of very large group plans are self-insured).

An example of this is the fact that adult dental care is not one of the essential health benefits mandated under the ACA, nor is adult dental care required to be covered under Medicaid (some states do include dental coverage in their Medicaid programs, while others don't).

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For example, most states mandate coverage for chiropractors, but the number of allowed visits may vary from state to state.

Mental health benefits If a health plan covers mental health services, the annual or lifetime dollar limits must be the same or higher than the limits for regular medical benefits.