Stated-mandated coverage for well-baby & well-woman exams

[Guest aws]

I am trying to find written confirmation of PA law regarding coverage for well-baby and well-woman exams under group health insurance policies. Can someone point me in the right direction?

[jeanine]

You don't give your background, and I'm going to assume you are asking in response to a particular situation involving a specific plan. First of all, any Pa. law regarding well-baby and well-woman exams only applies to plans that the state of Pa. may regulate. If the plan is a true insurance plan subject to state insurance law, then the law if it exists, can regulate the plan. Check on the internet if your state has an official state website. If it does, it will probably provide links to state law in codified form. From this site, you should be able to access specific provisions of the law by typing in key phrases. Be aware, however, if you are trying to find out if your plan must comply with any state laws, you must first find out if it is subject to state law. Plans provided by an employer who self-funds (pays all costs from the company's assets instead of buying an insurance policy)are exempt from state law by ERISA. ERISA does not require plans to offer well-baby or well-woman care. With more details on what and why you are asking, you may get a more detailed response than what I have been able to give you.

[Guest aws]

Thanks for your response. I'm a consultant responding to a specific request from our client. I've been to the PA State Website but got nowhere after much searching. The plan in question is a true insurance plan and I know the law applies, there is just some confusion over exactly what the law is. But I have had no luck finding it!

[jeanine]

Try calling the Pa. state department of insurance. One other very useful site I recommend is www.insure.com. I think there are links to state insurace sites on it. There is also a good forum for questions on all types of insurance, including health care insurance.

[Guest EMK]

Try www.pacode.com

[KIP KRAUS]

Its is true that state insurance laws apply in the staet where the group insurance is sited. However, some state insurance mandated coverages applied extrateritorialy to people who reside in a state regardless of where the contract is sited.

This is one of the main reasons employers go self-insured when they have employees in a number of states.