Data as of January 2010.

The vast majority of group health plans provide coverage for maternity care, including prenatal care. This is due in large part to the Pregnancy Discrimination Act of 1978 (PDA), an amendment to Title VII of the 1964 Civil Rights Act, that prohibits discrimination based on gender, pregnancy, childbirth, or pregnancy-related conditions. The PDA requires health plans sponsored by employers with 15 or more employees to cover pregnancy, childbirth, and pregnancy-related conditions in the same way as other temporarily disabling conditions. Though the PDA is not a mandated benefit law, per se, it has the effect of promoting maternity coverage under most employer-sponsored health plans. Enactment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) effectively broadened the reach of the PDA. HIPAA requires all health insurance policies for small employer groups (defined as firms with 2 to 50 employees) to be sold on a guaranteed issue basis. This means small employers not subject to the PDA nonetheless have the opportunity to buy policies with maternity benefits sold to larger employers.

Data compiled through review of federal and state law.
Data collection and analysis by researchers at the Health Policy Institute, Georgetown University.

Sometimes, state law require health insurance plans sold by licensed insurers to include coverage for a specific benefit. This is called a "mandate to cover". As an alternative, a state law health insurers to offer coverage for a specific benefit, but the person or group buying the policy does not have to elect coverage for that specific benefit. This is a "mandate to offer".

NA: Data are not available.

1. Applicable to HMOs only.

Data as of January 2010.

Under federal law, there is no mandate for health plans to provide coverage for the treatment of mental illness. However, if a large group health plan does offer mental health benefits, they must have parity with medical benefits. In October of 2008, the Mental Health Parity Act was amended (to go into effect in October 2009) to expand parity requirements to the treatment of substance abuse and to expand the definition of parity to include financial requirements and treatment limitations. Under the amendments, group health plans that offer mental health benefits and substance abuse treatment benefits must ensure parity with regards to annual and lifetime benefit limitations, as well as cost sharing, including copayments and coinsurance. Small employers are exempt from these requirements. Mandated coverage of mental health benefits, including eating disorders, is determined under state law.

Sometimes, state law requires health insurance plans sold by licensed insurers to include coverage for a specific benefit. This is called a "mandate to cover." As an alternative, a state law may require health insurers to offer coverage for a specific benefit, but the person or group buying the policy does not have to elect coverage for that specific benefit. This is a "mandate to offer."

States that require insurers to cover eating disorder benefits on the same basis as other medical benefits, with regard to both benefit levels and cost sharing receive "Full Parity." States that require insurers to cover eating disorder benefits on the same basis as other medical benefits, only with regard to either benefit levels or cost sharing, but not both, receive "Limited Parity." States that required coverage of eating disorder benefits, but do not require parity (eg. a state may require coverage of a set number of inpatient hospital days or a set dollar amount per year), receive "Minimum Benefit Standards."

Data compiled through review of federal and state law and interviews with government regulators. Data collection and analysis by researchers at the Health Policy Institute, Georgetown University.

NA: Data are not applicable.