Exclude coverage for pregnant dependents

[Guest MS. BLB]

I recently started a new job and noticed that our self-insured medical plan excludes coverage for pregnant dependents. I have never seen this and have understood that would be discriminatory. Does anyone have a comment, experience, etc. with this provision. Thanks.

[J Simmons]

The federal Pregnancy Discrimination Act of 1979 only covers employee benefits for the employee and employee's spouse. Not for the employee's child who might be pregnant.

However, you might check your state's laws.

[MARYMM]

The federal Pregnancy Discrimination Act of 1979 only covers employee benefits for the employee and employee's spouse. Not for the employee's child who might be pregnant.

However, you might check your state's laws.

Would state laws be applicable ? I thought one of the benefits of self-insuring was that the plan did not have to cover state mandated benefits.

[J Simmons]

The federal Pregnancy Discrimination Act of 1979 only covers employee benefits for the employee and employee's spouse. Not for the employee's child who might be pregnant.

However, you might check your state's laws.

Would state laws be applicable ? I thought one of the benefits of self-insuring was that the plan did not have to cover state mandated benefits.

If (a) the plan is subject to ERISA, and (b) the plan is not a MEWA, then agreed. From the OP, neither proposition is evident.

[jpod]

Question for Ms. BLB: Are you employed in HR or personnel or in some other position involving the administration of employee benefits? If so, it's good that you are asking questions about this.

If not, what exactly is your reason for asking? Whatever the answer is, what do you intend to do with that information? Just curious the day before a long holiday weekend.

[Guest MS. BLB]

Question for Ms. BLB: Are you employed in HR or personnel or in some other position involving the administration of employee benefits? If so, it's good that you are asking questions about this.

If not, what exactly is your reason for asking? Whatever the answer is, what do you intend to do with that information? Just curious the day before a long holiday weekend.

Hi and thanks for your post. I am a Benefits Manager and recently started with a new company. I had never seen pregnancy excluded for dependents in any other plan I worked with (20+ years) and while I agree with the answer above (and my own conclusion when reading about the Discrimination Act) it still bothers me because legally mandated or not, it seems discriminatory. We have a self-insured plan and when asking this question elsewhere (outside of this post) we received conflicting opinions. If I can find something concrete we will change the provision. If not, which is the case, the provision will stay in the plan and if someone decides to take legal action the outcome will be determined by the final opinion in accordance with how far the employee wants to take this. No one that I know of has challenged it thus far and I am currently checking to see how the claims are paid because this could simply be incorrect SPD language.

[jpod]

If administration of your plan is outsourced to an experienced and reputable TPA I would expect them to have their own counsel's legal analysis to support this exclusion. I doubt that your Company thought of this itself and foisted it upon the TPA who then said, simply, "ok, whatever you wish."

[Guest sniffles]

Our plan also excludes pregnant dependents (not spouse).

From the self-insured Employer's perspective, we want to provide the opportunity to cover our employees' spouse and dependents, NOT the dependents' dependent.

[jpod]

Sniffles: legalities aside, this isn't an issue of covering the dependent's dependents, it's an issue of whether you are going to exclude certain types of medical expenses incurred by an otherwise covered dependent. Given that, what exactly do you mean?

[Guest MS. BLB]

If administration of your plan is outsourced to an experienced and reputable TPA I would expect them to have their own counsel's legal analysis to support this exclusion. I doubt that your Company thought of this itself and foisted it upon the TPA who then said, simply, "ok, whatever you wish."

Well, you would think and I am sure you are correct, but it's better to question something that looks strange. Besides, the provision has been in place a lot longer than I have been around, I am a firm believer that a lot of things are based on opinion and that would be the opinion of the individual(s) handling whatever at that point in time. In fact, when I did ask, the TPA couldn't answer my question right away. But, my final conclusion is the provision is legal so I am calling it a day and will go on to the next thing on my list. Thanks for chatting with me.