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What must health insurance plans cover in your state? Posted: March 19th, 2012

By Barbara Marquand

Long before Congress passed the massive health care reform known as the Patient Protection and Affordable Care Act, states made their own rules for what health insurance plans must cover.

And today the list of state rules continues to grow.

Last year, the number of state health insurance mandates reached a record 2,262, with 106 new ones added in 2011 alone, according to a recent report from the Council for Affordable Health Insurance in Alexandria, Va. The number of state mandates for health insurance has more than doubled in the last 20 years.

State laws apply to individual health insurance plans and mostly small-group plans. Employer-sponsored self-insured plans are regulated by the federal government. Most large employers self-insure, which means they pay health claims from their own coffers rather than paying premiums to health insurance companies to cover the claims.

Health insurance mandates require insurers to cover certain procedures, patients, treatments or specific health care providers. Some states require health plans to cover chiropractors, for instance, or behavioral therapy for people with autism. Most states require coverage of breast, prostate and colorectal cancer screening. Mandates for diabetes supplies and related treatment are common, too.

The most popular mandates are for:

  • Mammography screening.
  • Minimum maternity stay.
  • Breast reconstruction.
  • Mental health parity.
  • Alcohol and substance abuse.

The least popular mandates are for:

  • Removal of breast implants.
  • Cardiovascular disease screening.
  • Circumcision.
  • Gastric electrical stimulation.
  • Organ transplant donor coverage.

States vary widely in the number of mandates they have. Rhode Island and Virginia, each with 70 mandates, have the most. They are followed by Maryland with 67, Minnesota with 65 and Connecticut with 63.

Idaho, with 13, has the lowest number of mandates, followed by Alabama with 19, Michigan with 23, Hawaii with 24 and Utah with 26.

Mandates tend to be popular with consumers and politicians. However, they increase costs of health insurance because they make insurance companies cover services consumers previously paid for themselves.

Mandated benefits increase the cost of basic health insurance coverage from less than 10 percent to more than 50 percent, depending on the type of health insurance policy, the state and the specific language of the law, according to the Council for Affordable Health Insurance.