Affordable Care Act Bans Sex Discrimination in Employer Health Plans

by King & Spalding
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Complaints filed Monday, June 3, 2013, with the Office for Civil Rights of the U.S. Department of Health and Human Services (OCR), allege that an employer that receives federal funding may not exclude pregnancy coverage in a health insurance plan offered to its employees’ dependents.  The National Women’s Law Center in Washington, D.C. filed the complaints against five large employers, including a Midwest health system, alleging that carving out pregnancy coverage illegally discriminates against women.

A provision of the Affordable Care Act (ACA) extended the reach of existing nondiscrimination laws to health care benefits.  Under section 1557 of ACA, codified at 42 U.S.C. § 18116, an individual may not “be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving Federal financial assistance.”  Entities receiving federal funds and health insurance exchanges created under ACA must comply with the nondiscrimination law.

Under ACA, most dependents now can remain on a parent’s insurance plan until age 26—slightly older than the mean age when a woman gives birth to her first child according to the CDC.  Click here for the CDC’s report about births in 2010. 

The complaints filed with OCR allege that Beacon Health System, Auburn University, and other private and public employers violated the nondiscrimination ban by excluding gynecology and maternity care coverage from insurance benefits offered to their employees’ dependents.  According to the complaint against Beacon Health System, for example, its benefit plan states that it “[e]xcludes dependent pregnancy.”  Beacon Health System owns Elkhart General Hospital, Memorial Hospital of South Bend, and other facilities in Indiana and Michigan. The complaint alleges that this type of exclusion deprives women who participate in a plan as dependents of the comprehensive insurance coverage that is offered to men who participate in the same plan.  The five complaints are available on the website of the National Women’s Law Center and may be accessed by clicking here.

If OCR concludes that an employer has violated the nondiscrimination law, it may require the employer to correct its health benefit plan.  If not corrected, the violation may trigger other enforcement actions including termination from participation in federal healthcare programs.  Any employer, including a health care organization, that receives federal funds may wish to examine its health benefit plan with respect to a pregnancy exclusion.  Additionally, any healthcare provider that delivers pregnancy services may wish to carefully scrutinize a denial of pregnancy benefits under a patient’s insurance plan that otherwise provides comprehensive coverage.

Reporter, Lynn M. Adam, Atlanta, +1 404 572 3528, ladam@kslaw.com.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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