Federal Laws
Family and Medical Leave Act
The Family and Medical Leave Act (FMLA) provides an entitlement of up to 12 weeks of job-protected, unpaid leave during any 12-month period to eligible, covered employees for the following reasons: 1) birth and care of the eligible employee’s child, or placement for adoption or foster care of a child with the employee; 2) care of an immediate family member (spouse, child, parent) who has a serious health condition; or 3) care of the employee’s own serious health condition. It also requires that employee’s group health benefits be maintained during the leave. The FMLA is administered by the Employment Standards Administration’s Wage and Hour Division within the U.S. Department of Labor.
Application of the FMLA can also be impacted by the Uniformed Services Employment and Reemployment Rights Act (USERRA), Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), the Americans with Disabilities Act of 1990 (ADA), or the Health Insurance Portability and Accountability Act (HIPAA).
The Mental Health Parity and Addiction Equity Act
Introduction: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that may apply to two different types of coverage:
- Large group self-funded group health plans.
- Large group fully insured group health plans.
Contact your state’s insurance department to find out about whether additional protections apply to your coverage if you are in a fully insured group health plan or have individual market (non-employment based) health coverage.
Summary of MHPAEA Protections: The Mental Health Parity Act of 1996 (MHPA) states that a group health plan may not impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical surgical benefits.
MHPAEA preserves the MHPA protections, and adds significant new protections. Although the law requires “parity”, or equivalence, with regard to annual and lifetime dollar limits, financial requirements and treatment limitations, MHPAEA does NOT require large group health plans and their health insurance issuers to include MH/SUD benefits in their benefits package. The law’s requirements apply only to large group health plans and their health insurance issuers that already include MH/SUD benefits in their benefit packages.
The Women’s Health and Cancer Rights Act
The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy.
This law may apply to three different types of coverage:
- Self-funded group health plans (CMS has jurisdiction over self-funded public sector (non federal governmental) plans while the Department of Labor 866-444-3272 has jurisdiction over private sector self-funded group health plans.);
- Fully insured group health plans; and
- Individual (non-employment based) health insurance policies.
The Newborns’ and Mothers’ Health Protection Act
The Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA) affects the amount of time you and your newborn child are covered for a hospital stay following childbirth. The law may apply to three different types of coverage:
- Self-funded group health plans (CMS has jurisdiction over self-funded public sector (non federal governmental) plans while the Department of Labor 866-444-3272 has jurisdiction over private sector self-funded group health plans.);
- Fully insured group health plans; and
- Individual (non-employment based) health insurance policies.
H.R. 2851: Michelle’s Law
110th Congress
2007-2008
Michelle's Law, passed last year, requires both self-funded and insured group health plans to provide up to one year of coverage for students who are on medically necessary leaves of absence from postsecondary educational institutions. The law is effective for plan years beginning on or after October 9, 2009, making it effective January 1, 2010 for calendar year plans. Employers should review their plans to ensure compliance for the upcoming plan year.
Continuation Coverage During Medical Leaves of Absence
Under Michelle's Law, an employer's group health plan must continue to provide coverage to a "dependent child" if the child takes a leave of absence from a postsecondary educational institution, or has a change in enrollment status, that:
- Begins when the student is suffering from a serious injury or illness;
- Is medically necessary (as confirmed in a written communication from the student's treating physician); and
- Causes the child to lose student status for purposes of coverage under the plan.
A "dependent child" for purposes of Michelle's Law is a child who (1) is a dependent child of a participant or beneficiary under the terms of the plan, and (2) was enrolled in the plan on the basis of being a student at a postsecondary educational institution immediately before the medical leave of absence began.
The plan must continue the child's coverage for up to one year after the leave of absence begins or, if earlier, until coverage would have otherwise terminated under the terms of the plan (for instance, if the child ages out of the plan or the child's parent terminates employment and loses coverage under the plan).
The level of benefits provided to the child during Michelle's Law continuation coverage must be the same as the benefits the child would have received if the child had continued as a covered student (without regard to Michelle's Law). The premium the plan charges the employee must also remain the same as if the child had maintained regular student status.
