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Mandated benefits for group health plans


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I want to resurrect a topic that was killed a while back. Not a bad idea for this time of year.

According to the just published article from the DOL, is the following question and answer on p. 20:

My group health plan excludes coverage for benefits for a certain health condition (without regard to whether it was preexisting in nature). Is my plan violating HIPAA's nondiscrimination provisions by imposing this exclusion?

Group health plans may exclude coverage for a specific disease, limit or exclude benefits for certain types of treatment or drugs, or limit or exclude benefits based on a determination of whether the benefits are experimental or medically necessary, if the benefit restriction is applied uniformly to all similarly situated individuals and is not directed at any individual participants or beneficiaries based on a health factor. (Plan amendments applicable to all individuals in a group of similarly situated individuals and made effective no earlier than the first day of the next plan year after the amendment is adopted are not considered to be directed at individual participants and beneficiaries).

Using this explanation for group health plans, I read that the plan sponsor can amend his plan in any way, except for a discriminatory fashion. How would mandated benefit laws that apply to plan issuers have any impact on the plan sponsor?

By the way, don't take my word for it. Go to: http://www.dol.gov/ebsa/pdf/hipaaemployer.pdf.

Don Levit

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