Mandated benefit

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What is a mandated benefit?

A mandated benefit is a healthcare service for which health insurance plans must provide coverage.

Mandated benefits cover the treatment of specific health conditions, certain types of healthcare providers, and some categories of dependents, such as children placed for adoption.

Federal and state laws specify mandated benefits. Between the federal government and the states, there are approximately 2000 health insurance mandates.

Mandated health insurance laws passed at either the federal or state level usually fall into one of three categories:

  1. Health care services or treatments that must be covered, such as substance abuse treatment, contraception, in vitro fertilization, maternity services, prescription drugs, and smoking cessation.
  2. Healthcare providers other than physicians, such as acupuncturists, chiropractors, nurse midwives, occupational therapists, and social workers.
  3. Dependents and other related individuals, such as adopted children, dependent students, grandchildren, and domestic partners.

The mandated benefit laws most often apply to health insurance coverage offered by employers and private health insurance purchased directly by an individual.