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A Growing List

By Staff Reporters

State laws inform health insurers what health coverage they must offer as state mandates. For example, if a state says “behavioral health coverage,” then health insurance policies issued in that state must provide coverage for behavioral health benefits for the insured and dependents But, recall that no two states impose the same set of mandates, and coverage changes regularly. So, here is a list:

Alabama

• Alcohol treatment
• dependent coverage (from the moment of birth, including abnormalities)
• mammograms
• open selection of pharmacy

Alaska

• Alcohol/drug treatment
• dependent coverage (from the moment of birth, including abnormalities, and those who are adopted)
• mammography
• pap smears
• prostate cancer screenings
• phenylketonuria

Arizona

• Dependent coverage (from the moment of birth, including those who are physically or mentally handicapped, and those who are adopted) mammography
• outpatient care
• home health care
• mastectomy reconstruction
• emergency care
• diabetes self-management; mail-order pharmacies may not be required
• prescription contraceptives (exceptions exist for religious employers)

California

• Alcohol/drug/nicotine treatment
• mental health coverage
• dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammography
• lead screening for children
• preventative care for children
• home health care
• infertility treatment
• mastectomy and other reconstruction
• diabetes self-management
• pap smears
• temporomandibular joint disorder
• prosthetic devices
• osteoporosis
• off-label drugs
• DES effects
• prostate cancer screening

Colorado

• Alcohol treatment
• mental health coverage
• dependent coverage (from the moment of birth, including those with abnormalities, and those who are adopted)
• mammography
• home health care
• hospice care
• maternity coverage for women
• pregnancy complications
• prostate cancer screenings
• coverage may not be denied to an individual solely on the basis that the individual casually or professionally participates in skiing or snowboarding activities

Connecticut

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
• mammography
• home health care
• comprehensive rehabilitation
• occupational therapy
• long-term care
• metabolic disorders
• mastectomy reconstruction
• breast implant removal
• diabetes
• ambulance services
• cancer
• accidental ingestion of controlled drugs

Delaware

• Mental health coverage
• dependent coverage (from the moment of birth, including abnormalities)
• cancer screening (including Pap tests, mammograms, ovarian cancer, and prostate screenings)
• lead screening
• children’s immunizations

District of Columbia

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities and preventive care)
• mammography
• Pap tests

Florida

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• second surgical opinions
• HIV testing/infection
• fibrocystic breast disease
• ambulatory surgical care
• mastectomy
• reconstructive surgery
• home health care
• acupuncture
• mammograms
• diabetes
• temporomandibular joint disorders
• osteoporosis

Georgia

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• pregnancy complications
• mammography
• Pap tests
• bone marrow transplants
• prostate cancer screening
• diabetes
• heart transplants
• outpatient services
• osteoporosis
• chlamydia screening
• pharmacy open choice

Hawaii

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities, those who are mentally or physically handicapped, and those who are adopted,)
• maternity expenses if employee covered for past nine months
• mammography
• in vitro fertilization
• contraceptive services
• emergency services
• telehealth

Idaho

• Dependent coverage (from the moment of birth
• including abnormalities
• those who are mentally or physically handicapped, and those who are adopted)
• if mastectomy covered so must mammography be
• elective abortions must be excludable
• involuntary complications of pregnancy

Illinois

• Alcohol treatment
• mental health coverage
• dependent coverage (from the moment of birth, including those who are mentally or physically handicapped, and those who are adopted)
• mammography
• examinations of criminal assault or abuse victims
• infertility when maternity is covered
• mastectomy
• reconstructive surgery
• nonexperimental organ transplants
• treatment for DES children
• blood processing
• temporomandibular joint disorders
• ambulance service
• off-label cancer drugs
• fibrocystic breast disease
• breast implant removal
• colorectal cancer screening
• diabetes

Indiana

• Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammography
• mastectomy reconstruction
• diabetes self-management
• off-label drugs
• infant screening exams where maternity is covered
• prostate cancer screening
• colorectal cancer exams
• morbid obesity
• pervasive developmental disorders
• mental health

Kansas

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities, and adopted children)
• mammograms
• Pap smears
• emergency care

Kentucky

• Alcohol treatment
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities)
• mammography and reconstruction where mastectomy is covered
• ambulatory surgery care
• home health care
• long-term care
• bone marrow transplants
• temporomandibular joint disorders
• endometriosis
• diabetes self-management
• off-label cancer drugs
• hearing aids and related services

Louisiana

• Dependent coverage (from the moment of birth, including abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammography
• Pap tests
• ambulatory surgery care
• immunizations for children
• mastectomy reconstruction
• diabetes self-management
• prostate cancer screening
• emergency care
• off-label cancer drugs
• outpatient surgery
• use of mail-order pharmacies cannot be mandatory

Maine

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities, and those who are adopted)
• mammography
• home health care
• AIDS coverage (cannot be more restrictive than for other illnesses)
• mastectomy reconstruction
• diabetes self-management
• Pap tests
• outpatient services
• off-label cancer and HIV drugs
• prostate cancer screening
• breast prostheses for mastectomies
• clinical trials
• emergency services

Maryland

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities, and adopted children or grandchildren)
• hospice care
• home health care
• child wellness
• metabolic disorders
• mammograms
• infertility if maternity is covered
• certain blood products
• mastectomy reconstruction
• diabetes
• prostate cancer screenings
• temporomandibular joint disorders
• outpatient care
• osteoporosis
• pharmacy of choice
• tuberculosis
• off-label drugs
• contraceptives
• chlamydia screening
• hospice care
• emergency care

Massachusetts

• Alcohol/drug treatment (only if you have more than five employees)
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities, and those who are adopted)
• mammography
• infertility treatments
• home health care
• pregnancy and childbirth
• hospice care
• ABMT (treatment for breast cancer)
• preventive care for children
• enteral nutrition
• DES-related conditions
• diabetes management
• Pap tests
• off-label drugs for HIV/AIDS
• scalp hair prostheses
• cardiac rehabilitation

Michigan

• Dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped)
• mastectomy reconstruction and prosthetics
• emergency care
• off-label cancer drugs
• hospice care

Minnesota

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• home health care
• well-baby care
• emergency care
• some diabetes treatment
• prenatal care
• mammograms and other cancer screening
• breast-implant-related conditions
• reconstructive surgery
• exposure to DES
• phenylketonuria
• port wine stains
• Lyme disease
• Pap tests
• temporomandibular joint disorders
• outpatient care
• off-label cancer drugs
• fibrocystic breast disease
• scalp hair prostheses

Missouri

• Alcohol/drug treatment
• dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
• mammography
• preventive care for children
• bone marrow transplants
• reconstructive surgery after mastectomy
• phenylketonuria
• diabetes self-management
• speech or hearing loss
• elective abortions may be covered only under separate policy riders for which additional premiums are paid

Mississippi

• Alcohol treatment
• dependent coverage (from the moment of birth, including abnormalities and those who are physically or mentally handicapped)
• temporomandibular joint disorders
• open choice of pharmacy
• off-label cancer drugs
• mammography
• diabetes
• dental anesthesia

Montana

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
• mammography
• home health care
• inpatient care for breast surgery
• mastectomy reconstruction
• phenylketonuria
• metabolic disorders
• open choice of pharmacy

Nebraska

• Mental health coverage
• dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped)
• childhood immunizations
• mammograms
• emergency care
• off-label cancer and HIV/AIDS drugs
• temporomandibular joint disorders
• diabetes
• abortions only to prevent death of mother
• use of mail-order pharmacies can’t be mandatory

New Hampshire

• Mental health coverage
• dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
• nonprescription enteral formulas
• mammograms
• bone marrow transplants
• mastectomy reconstruction
• diabetes self-management
• certain hair-loss prostheses
• dental anesthesia

New Jersey

• Alcohol treatment
• dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped)
• mammography
• Pap smears
• second and third (sometimes) surgical opinions
• reconstructive breast surgery and prostheses
• home health care
• blood tests
• glaucoma tests
• adult immunizations
• wellness examinations
• childhood immunizations for plans with over 49 enrollees
• metabolic disorders
• bone marrow transplants
• maternity care
• hemophilia blood products
• diabetes self-management
• lead poisoning screenings
• prostate cancer screening
• colon screening
• open choice of pharmacy
• off-label drugs
• dental anesthesia

New Mexico

• Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammography
• childhood immunizations
• diabetes
• Pap tests
• ambulance service for childbirth

Nevada

• Alcohol/drug treatment
• dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammography
• mastectomy
• reconstructive surgery and prosthetics
• enteral formulas and special food products ordered by a physician
• diabetes self-management
• Pap tests
• temporomandibular joint disorders
• pregnancy and childbirth

New York

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped and those who are adopted)
• mammography
• home health care
• preadmission tests
• second surgical opinions
• infertility treatment
• preventive pediatric care
• prescription enteral formulas
• mastectomy reconstruction
• maternity care
• diabetes self-management
• Pap tests
• emergency care
• nursing home care
• hospice care
• off-label cancer drugs

North Carolina

• Dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted or foster children)
• mammography
• Pap tests
• mastectomy reconstruction
• diabetes self-management
• prostate cancer screening
• open choice of pharmacy
• off-label cancer drugs

North Dakota

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammography
• free choice of pharmacy
• prostate cancer screening
• temporomandibular joint disorder
• dental anesthesia

Ohio

• Alcohol/drug treatment
• dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammograms
• Pap tests

Oklahoma

• Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammography
• childhood immunizations
• mastectomy reconstruction
• diabetes
• bone density tests
• dental anesthesia
• prostate surgery side effects
• prostate cancer screenings

Nevada

• Alcohol/drug treatment
• dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammography
• mastectomy
• reconstructive surgery and prosthetics
• enteral formulas and special food products ordered by a physician
• diabetes self-management
• Pap tests
• temporomandibular joint disorders
• pregnancy and childbirth

Pennsylvania

• Alcohol/drug treatment
• dependent coverage (including those who are mentally or physically handicapped)
• annual gynecological exams and Pap smears
• mammograms
• mastectomy reconstruction and prosthetics
• phenylketonuria
• diabetes self-management

Rhode Island

• Alcohol/drug treatment, mental health coverage, dependent coverage (including those who are adopted)
• home health care
• pediatric preventive care
• mammograms
• mastectomy reconstruction and prosthetics
• new cancer therapies
• diabetes
• Pap tests
• second surgical opinions
• infertility treatments
• bone marrow donor testing abortion may be covered only under a separate rider, and only if mother endangered, rape, or incest

South Carolina

• Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• off-label cancer drugs
• gynecological exams
• mammograms
• mastectomy reconstruction
• Pap tests
• prostate cancer screenings
• emergency care
• open choice of pharmacy

South Dakota

• Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammography
• phenylketonuria
• open choice of pharmacy
• diabetes self-management
• emergency care

Tennessee

• Dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
• mammography
• mastectomy reconstructions
• phenylketonuria
• diabetes
• prostate cancer screening
• emergency care

Texas

• Alcohol/drug treatment
• dependent coverage (from the moment of birth, including those with abnormalities, those who are physically or mentally handicapped, and those who are adopted)
• coverage for AIDS (including HIV and HIV-related conditions)
• infertility including in vitro fertilizations where pregnancy/childbirth is covered
• childhood immunizations
• mammograms
• mastectomy reconstruction
• diabetes
• prostate cancer screening
• temporomandibular joint disorders
• free choice of pharmacy
• home health care
• telemedicine
• emergency care

Utah

• Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• metabolic disorders
• maternity benefits for birth mothers in adoptions
• genetic information may not be used for purposes other than treatment

Vermont

• Alcohol treatment
• mental health coverage
• dependent care coverage (from the moment of birth, including abnormalities, those with physical or mental handicaps, and those who are adopted)
• mammography
• certain cancer therapies
• diabetes self-management
• home health care
• metabolic disorders
• craniofacial disorders

Virginia

• Alcohol/drug treatment
• mental health coverage
• dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
• mammography
• pregnancy treatment after rape or incest
• HDC/ABMT (breast cancer treatment)
• Pap tests
• temporomandibular joint disorders
• emergency care
• early intervention therapies for children
• open choice of pharmacy
• off-label drugs
• contraceptives
• mastectomy reconstruction
• hemophilia
• diabetes
• prostate cancer screening
• cancer pain
• hospice care

Washington

• Alcohol/drug treatment
• dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• home health care
• mammography
• breast reconstruction
• hospice care

West Virginia

• Dependent coverage (from the moment of birth, including abnormalities and those who are adopted)
• home health care
• primary care nursing
• rehabilitation services
• mammograms
• diabetes
• Pap tests
• temporomandibular joint disorders
• emergency care
• childhood immunizations
• cannot cancel if diagnosed with AIDS

Wisconsin

• Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
• mammography
• diabetes supplies
• HIV drugs
• home health care
• kidney disease treatments
• skilled nursing care
• maternity care
• emergency care
• open choice of pharmacy

Wyoming

• Dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)

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Alcohol Treatment: http://www.altamirarecovery.com/alcohol-treatment/

Conclusion

What do you think? As always, your thoughts and comments on this Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com or Bio: http://www.medicalbusinessadvisors.com/marcinkobio.asp and www.stpub.com/pubs/authors/MARCINKO.htm

Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: Health Insurance, Health Law & Policy, Insurance Matters, Managed Care, Quality Initiatives, Uncategorized | Tagged: state health insurance mandates | 6 Comments »