What is a Mandate Benefit?
A mandate benefit is medical coverage required by the state or the federal law to be included in a health insurance policy. These benefits are medical services that the federal law or the state requires health insurance companies to include in the products that they sell. Another form of a mandate benefit is through some federal laws of some states requiring employers or managed care companies to provide medical coverage to employees (and by extension, their dependents) thus becoming a mandated benefit. The list of mandate benefits varies from each state as well as the specific terms being observed. Moreover, these mandated benefits being dictated by the state or federal law have been always controversial since it began.
A brief history of how the mandate benefit was created is to look at 1965 where the number of uninsured Americans was growing and insurance policies were unaffordable to the general population. Health insurance was then encouraged to be lower in cost and affordable by most by conservative policymakers but this would also mean that the benefits included in the policies are less given the lower cost. Politicians then ensured that the less expensive health insurance policies still maintain the medical coverage of the most basic and important needs. What began as seven mandated benefits by the law in 1965 grew to more than 1,800 benefit requirements adopted in 50 states today. There is a wide debate about the increase of cost in most health insurance policies because of these mandate benefits.
In most states, mandate benefits dictated by state or federal law are only applicable to group insurance, employers, or companies. If purchased individually for personal insurance, sometimes the mandate benefits do not apply. In some states however, the laws are applicable to all and there might be no exceptions. A specific list of these mandates typically include coverage for treatment of specific health conditions, some categories of dependents (like children placed for adoption), and for certain health care providers.
Most of the laws passed at either state or federal level could fall in any of the three categories below:
• Dependents (i.e. adopted children, dependent student, domestic partners, grandchildren, and other related individuals)
• Healthcare providers other than physicians (i.e. chiropractors, acupuncturists, midwives, occupational therapist, and etc.)
• Healthcare services and treatments (i.e. substance abuse, in vitro fertilization, contraception, maternity services, prescriptions, and etc.)
The terms aside from the adopted mandates for a particular state also vary. For example, one state may allow a minimum number of 3 chiropractor visits in a year and another state may allow 5. If you want to know more about the particular mandate benefits that are imposed in the state that you live in, you can ask your health insurance agent or someone working in the department that regulates these laws being passed in your state.