COST OF EXISTING MANDATED HEALTH INSURANCE BENEFITS Est. Type of Year Maximum Benefit Contract Enacted Cost as % of Affected Premium Must include benefits for dentists’ services to the extent 1975 that the same services be covered if performed by a All Contracts physician. 0.10% Benefits must be included for treatment of alcoholism Groups 0.40% 1983 and drug dependency. Individual 2.50% 1975 Groups 3.80% 1983 Benefits must be included for Mental Health Services, 1995 including psychologists and social workers. Individual 2.60% 2003 1986 Benefits must be included for the services of 0.87% 1994 chiropractors to the extent that the same services would 1995 be covered by a physician. Benefits must be included for Individual 1.42% 1997 therapeutic, adjustive and manipulative services. Group 0.68% 1990 Benefits must be made available for screening 1997 mammography. Individual 0.76% Must provide coverage for reconstruction of both 1995 breasts to produce symmetrical appearance according to All Contracts patient and physician wishes. 0.02% Must provide coverage for metabolic formula and up to 1995 $3,000 per year for prescribed modified low-protein food All Contracts products. 0.01% If policies provide maternity benefits, the maternity (length of stay) and newborn care benefits must be 1996 All Contracts provided in accordance with for Prenatal “Guidelines Care.” 0 Benefits must be provided for medically necessary 1996 equipment and supplies used to treat and All Contracts diabetes approved self-management and education training. 0.20% 1996 Benefits must be provided for screening Pap tests. All 0.01% Benefits must be provided for annual gynecological Group managed 1996 exam without prior approval of primary care physician. care 0.10% Benefits provided for breast cancer treatment for a 1997 medically appropriate period of time determined by the All Contracts physician in consultation with the patient. 1.51% Coverage required for off-label use of prescription 1998 All Contracts drugs for treatment of cancer, HIV, or AIDS. 0.30% 1998 Coverage required for prostate cancer screening. All Contracts 0.07%
COST OF EXISTING MANDATED HEALTH INSURANCE BENEFITS Year Enacted Benefit Type of Contract Affected Est. Maximum Cost as % of Premium 1975 Must include benefits for dentists’ services to the extent that the same services be covered if performed by a physician. All Contracts 0.10% 1983 Benefits must be included for treatment of alcoholism and drug dependency. Groups 0.40% Individual 2.50% 1975 1983 1995 2003 Benefits must be included for Mental Health Services, including psychologists and social workers. Groups 3.80% Individual 2.60% 1986 1994 1995 1997 Benefits must be included for the services of chiropractors to the extent that the same services would be covered by a physician. Benefits must be included for therapeutic, adjustive and manipulative services. 0.87% Individual 1.42% 1990 1997 Benefits must be made available for screening mammography. Group 0.68% Individual 0.76% 1995 Must provide coverage for reconstruction of both breasts to produce symmetrical appearance according to patient and physician wishes. All Contracts 0.02% 1995 Must provide coverage for metabolic formula and up to $3,000 per year for prescribed modified low-protein food products. All Contracts 0.01% 1996 If policies provide maternity benefits, the maternity (length of stay) and newborn care benefits must be provided in accordance with “Guidelines for Prenatal Care.” All Contracts 0 1996 Benefits must be provided for medically necessary equipment and supplies used to treat diabetes and approved self-management and education training. All Contracts 0.20% 1996 Benefits must be provided for screening Pap tests. All 0.01% 1996 Benefits must be provided for annual gynecological exam without prior approval of primary care physician. Group managed care 0.10% 1997 Benefits provided for breast cancer treatment for a medically appropriate period of time determined by the physician in consultation with the patient. All Contracts 1.51% 1998 Coverage required for off-label use of prescription drugs for treatment of cancer, HIV, or AIDS. All Contracts 0.30% 1998 Coverage required for prostate cancer screening. All Contracts 0.07%