State and federal mandated benefits & services

Health care benefits

Covered providers

Anesthesia for dental services
Chemical dependency
Colorectal cancer exams and laboratory tests
Congenital anomalies in children and newborns
Diabetes coverage
Emergency medical services in an emergency
department
Injuries caused by intoxication or narcotics
Mammograms
Maternity and drug coverage
Mental health parity
Neurodevelopmental therapies
Phenylketonuria (PKU)
Prostate cancer screening
Women's health care services

Chiropractic care
Chiropractic care - access
Dentistry
Denturist services
Every category of provider
Optometry
Podiatry/Chiropody
Registered nurses and ARNPs
Psychological services
Women's health care – direct access

Benefits that must be offered

Other coverage requirements

Home health care, hospice
Prenatal diagnosis of congenital disorders
Temporomandibular joint disorder (TMJ)

Continuation of former family members
Conversion contracts
Coordination of Benefits (COB)
Coverage at a LTC facility after hospitalization
Dependent child coverage
Mastectomy, lumpectomy

Federal mandates
*Overlaps with state benefit mandate

Continuation of coverage/COBRA*
Coverage of adoptive children*
Mental health and substance abuse parity*
Newborns and Mothers: Minimum hospital stays* [Erin Act]
Reconstructive surgery after mastectomy*
Americans with Disabilities Act – ADA
Family and Medical Leave Act – FMLA
Qualified Medical Child Support Orders
Required coverage for certain pediatric vaccines
Uniformed Services Employment and Reemployment Rights Act – USERRA
Pregnancy Discrimination Act
Lifetime limits – all plans Annual Limits – All plans except grandfathered individual plans
Coverage of preventive health services – all non-grandfathered plans
Extension of adult dependent coverage – all plans*
Rescissions*
Pre-existing condition exclusions – All plans except grandfathered individual plans