Mandated benefits (also known as “mandated health insurance benefits” and “mandates”) are benefits that are required to cover the treatment of specific health conditions, certain types of healthcare providers, and some categories of dependents, such as children placed for adoption.A number of health care benefits are mandated by either state law, federal law — or in some cases — both.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.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.But there are also mandates that apply to Medicare and Medicaid/CHIP.
If someone who has a medical problem goes without necessary health care because it is not covered by her insurance, she may become sicker and need more expensive services in the future.
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.
The mandate laws differ from state to state and even for the same mandate, the rules and regulations may vary.
For example, most states mandate coverage for chiropractors, but the number of allowed visits may vary from state to state.
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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.