Government mandating

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Family and Medical Leave Act (FMLA)Requires an employer to maintain health coverage for the duration of a FMLA leave.Uniformed Services Employment and Reemployment Rights Act (USERRA)Gives an employee the right to continuation of health coverage under the employer’s health plans while absent from work due to service in the uniformed services.You can find information about individual state mandates from several sources: Under the ACA, all new (effective since 2014) individual and small group plans in all states must include coverage for the EHBs, must have adequate provider networks, and must cover pre-existing conditions and be issued without regard for medical history.That's the minimum standard to which the plans must adhere, but states can go beyond the ACA's requirements.Reconstructive surgery after mastectomy A health plan must provide someone who is receiving benefits related to a mastectomy with coverage for reconstruction of the breast on which a mastectomy has been performed.Americans with Disabilities Act (ADA)Disabled and nondisabled individuals must be provided the same benefits with regard to premiums, deductibles, limits on coverage, and pre-existing condition waiting periods.

But there are rules that require states—rather than insurers—to cover the cost of benefit mandates that go beyond the ACA's requirements, which means that some states have opted to apply new mandates only to large group plans, which aren't subject to the ACA's essential health benefit requirements (note however, that self-insured plans are regulated under federal rules rather than state oversight, so they are not subject to new requirements that states impose; the majority of very large group plans are self-insured).

One state may limit the number of chiropractor visits to four each year while another state may allow up to 12 chiropractor visits each year.

Since chiropractor services can be expensive, the impact on health insurance premiums may be greater in the state with the more generous benefit.

An example of this is the fact that adult dental care is not one of the essential health benefits mandated under the ACA, nor is adult dental care required to be covered under Medicaid (some states do include dental coverage in their Medicaid programs, while others don't).

The resulting lack of access to affordable dental care can result in serious long-term complications.

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