March 24, 2004 |
2004-R-0277 | |
COST OF MANDATED BENEFITS FOR HEALTH INSURANCE POLICIES | ||
By: Janet Brierton, Associate Legislative Attorney | ||
You asked several questions regarding mandated health insurance benefits. Specifically, you asked: (1) for a list of Connecticut’s insurance mandates with an estimated cost impact of each, (2) if Connecticut has more insurance mandates than other states, and (3) if the mandates only apply to insured policies underwritten by licensed insurance companies and not to self-insured plans.
SUMMARY
Enclosed is a previous OLR Research Report that provides a list of Connecticut’s mandated benefits for group and individual health insurance (OLR 2004-R-0148).
Table 1 below provides information regarding the estimated cost impact of mandates as of February 1, 2000. The Connecticut Insurance Department obtained minimum and maximum cost estimates for each mandate in effect at that time from insurance companies. The cost impact is shown as a percentage of the total premium charged. For all mandates listed, the total cost impact reported reflects a range of 6. 1% minimum to 46. 3% maximum.
Table 2 shows the number of state mandates per state as tracked by Blue Cross and Blue Shield Association (BCBSA) as of December 2003. According to BCBSA, Connecticut has 49 mandates, which is the 5th highest behind Maryland (58), Virginia (53), California (51), and Texas (50). The average number of mandates per state is 34. This information is summarized in Figure 1.
In general, the state health insurance mandates apply only to policies delivered, issued for delivery, or renewed in Connecticut. Federal courts have interpreted the Employee Retirement Income Security Act of 1974, as amended from time to time, (ERISA) as preempting the application of state insurance laws and regulations to self-insured health plans. Consequently, state mandated benefits are generally not applicable to employers that self-insure their employee benefit plans.
Table 1: COST OF GROUP HEALTH INSURANCE MANDATES AS OF FEBRUARY 1, 2000
Benefit Mandate |
Minimum Cost* |
Maximum Cost* |
Pre-Existing Condition Provision (38a-476) |
0. 10% |
10. 00% |
Mental Illness Benefits (38a-514) |
0. 83% |
10. 00% |
Biologically-Based Mental Illness (38a-514a) |
0. 25% |
5. 00% |
Mentally or Physically Handicapped Dependant Children (38a-515) |
0. 01% |
3. 00% |
Newborn Infants |
0. 10% |
2. 80% |
Birth-to-Three Early Intervention Services (38a-516a) |
0. 01% |
1. 00% |
Accidental Ingestion of a Controlled Substance (38a-518) |
0. 01% |
0. 25% |
Hypodermic Needles and Syringes (38a-518a) |
0. 01% |
1. 60% |
Off-Label Cancer Drugs (38a-518b) |
0. 10% |
1. 50% |
Protein Modified Food and Specialized Formula (38a-518c) |
0. 01% |
0. 50% |
Diabetes (38a-518d) |
0. 10% |
2. 00% |
Offset Provision (38a-519) |
0. 01% |
0. 25% |
Home Health Care (38a-520) |
0. 10% |
1. 00% |
Comprehensive Rehabilitation Services – Optional (38a-523) |
0. 06% |
1. 00% |
Occupational Services (38a-524) |
0. 10% |
1. 06% |
Ambulance Services (38a-525) |
0. 10% |
0. 70% |
Emergency Services; 911 Call (38a-525a) |
0. 01% |
0. 25% |
Nurse Practitioners (38a-526) |
0. 10% |
0. 50% |
Work-Related Injuries (38a-527) |
0. 01% |
1. 00% |
Alcoholism (38a-533) |
0. 07% |
3. 00% |
Table 1 -Continued-
Benefit Mandate |
Minimum Cost* |
Maximum Cost* |
Veterans (38a-529) |
0. 01% |
0. 25% |
Mammography (38a-530) |
0. 10% |
2. 00% |
Breast Cancer Survivors (38a-530a) |
0. 01% |
3. 00% |
Direct Access to OB/GYN (38a-530b) |
0. 10% |
0. 25% |
Maternity Care - 48/96 hours (38a-530c) |
0. 10% |
7. 60% |
Mastectomy – 48 hours (38a-530d) |
0. 02% |
0. 25% |
Preventive Pediatric Care (38a-535) |
0. 09% |
7. 00% |
Infertility – Optional (38a-536) |
0. 20% |
2. 50% |
Outpatient Substance Abuse Treatment – Optional (38a-539) |
0. 10% |
2. 00% |
Spouse as Dependant and Employee (38a-541) |
0. 10% |
0. 10% |
Tumors, Leukemia and Breast Implant Removal (38a-542) |
0. 02% |
8. 10% |
Age Discrimination – Small Group under 20 Employees (38a-543) |
0. 01% |
0. 10% |
Chiropractic Services (38a-534) |
0. 10% |
2. 20% |
Continuation, Extension and Conversion (38a-546(a), 38a-554(b) & (d)) |
0. 15% |
3. 00% |
Continuation of Maternity Benefits (38a-547) |
0. 00% |
1. 00% |
Adoptive Children (38a-549) |
0. 02% |
0. 50% |
Contraceptives (38a-530e) |
0. 03% |
2. 50% |
Mental Illness Parity (38a-514) |
0. 20% |
10. 00% |
Diabetes Self-Management Training (38a-518e) |
0. 06% |
0. 28% |
Lyme Disease Treatment (38a-518h) |
0. 09% |
0. 69% |
Prostate Screening (38a-518g) |
0. 10% |
0. 50% |
Dental Services (38a-517a) |
0. 01% |
0. 25% |
TOTAL COST OF MANDATES |
6. 10% |
46. 30% |
Source: Connecticut Insurance Department
* Minimum and maximum range of cost per group health insurance mandate as reported by companies.
Table 2: NUMBER OF INSURANCE MANDATES PER STATE AS OF DECEMBER 2003
|
STATE |
NUMBER OF MANDATED BENEFITS |
NUMBER OF MANDATED PROVIDERS AND PERSONS COVERED |
TOTAL |
Alabama |
7 |
8 |
15 |
Alaska |
11 |
16 |
27 |
Arizona |
12 |
11 |
23 |
Arkansas |
16 |
16 |
32 |
California |
31 |
20 |
51 |
Colorado |
20 |
19 |
39 |
Connecticut |
30 |
19 |
49 |
Delaware |
14 |
7 |
21 |
District of Columbia |
14 |
4 |
18 |
Florida |
21 |
24 |
45 |
Georgia |
30 |
11 |
41 |
Hawaii |
15 |
7 |
22 |
Idaho |
5 |
5 |
10 |
Illinois |
18 |
15 |
33 |
Indiana |
14 |
15 |
29 |
Iowa |
8 |
12 |
20 |
Kansas |
16 |
15 |
31 |
Kentucky |
22 |
10 |
32 |
Louisiana |
23 |
17 |
40 |
Maine |
24 |
19 |
43 |
Maryland |
35 |
23 |
58 |
Massachusetts |
22 |
17 |
39 |
Michigan |
11 |
10 |
21 |
Minnesota |
27 |
21 |
48 |
Mississippi |
11 |
12 |
23 |
Missouri |
23 |
13 |
36 |
Montana |
15 |
20 |
35 |
Nebraska |
12 |
14 |
26 |
Nevada |
18 |
27 |
45 |
New Hampshire |
19 |
17 |
36 |
New Jersey |
25 |
14 |
39 |
New Mexico |
22 |
17 |
39 |
New York |
25 |
17 |
42 |
North Carolina |
24 |
20 |
44 |
Table 2 -Continued-
|
STATE |
NUMBER OF MANDATED BENEFITS |
NUMBER OF MANDATED PROVIDERS AND PERSONS COVERED |
TOTAL |
Ohio |
11 |
14 |
25 |
Oklahoma |
17 |
11 |
28 |
Oregon |
13 |
13 |
26 |
Pennsylvania |
14 |
17 |
31 |
Rhode Island |
23 |
15 |
38 |
South Carolina |
14 |
11 |
25 |
South Dakota |
11 |
21 |
32 |
Tennessee |
19 |
17 |
36 |
Texas |
26 |
24 |
50 |
Utah |
9 |
27 |
36 |
Vermont |
15 |
8 |
23 |
Virginia |
31 |
22 |
53 |
Washington |
18 |
19 |
37 |
West Virginia |
20 |
13 |
33 |
Wisconsin |
17 |
13 |
30 |
Wyoming |
8 |
24 |
32 |
Source: Blue Cross and Blue Shield Association, December 2003
FIGURE 1: STATES PER NUMBER OF INSURANCE MANDATES
JB: nf