Health and disability insurance
Q. Must you provide benefits for pregnancy-related conditions even if you have a predominantly female work force or if you employ all women for a specific job classification?
A. Yes. You must provide benefits for pregnancy if you offer benefits for other medical conditions.
Q. Can your company limit pregnancy disability insurance benefits to only married employees?
A. No. Single women who become pregnant also must be covered under your disability plan.
Q. How long are you required to pay disability benefits for pregnancy if you provide income maintenance benefits for other temporary disabilities?
A. Generally, you must provide benefits for as long as a pregnant woman is unable to work for medical reasons; however, you may set certain time limits if you impose them on other temporary disabilities.
Q. If you comply with a state law that requires disability insurance for a specific period before and after childbirth, are you automatically in compliance with the federal pregnancy law?
A. Not necessarily. Under federal law, you must treat employees who are temporarily disabled due to pregnancy in the same manner as you would employees temporarily disabled by other conditions.
Q. Can you require a pregnant employee to use up her vacation benefits before she can collect sick leave or disability pay?
A. Yes, but only if you have the same requirements for employees absent for other types of disabilities or illnesses. You should state this in your FMLA policy.
Q. Must your health insurance plan cover the pregnancy-related expenses of spouses of your male employees? Of other dependents?
A. If an employer’s plan covers medical expenses of spouses of female employees, it must cover the expenses of spouses of male employees, including pregnancy. Insurance coverage for pregnancy need not be extended to include other dependents as long as it excludes pregnancy benefits for dependents of both male and female employees.
Q. Can an employer limit payment of costs resulting from pregnancy-related conditions to a specific dollar amount stipulated in an insurance policy, collective bargaining pact or other statement of employee benefits?
A. Yes. Maximum recoverable dollar amounts can be set for pregnancy-related conditions, provided the amounts are specified for other conditions and the specified amounts in all instances cover the same proportion of actual costs. Note that an employer must pay additional costs for pregnancy-related procedures if additional payments are made for other procedures.
Q. Can you establish a different deductible for pregnancy-related conditions than you do for the costs of other medical conditions?
A. No. You may not tack on an additional deductible or increase the usual deductible for coverage of pregnancy, either as a condition for inclusion of pregnancy costs or for the payment of costs when incurred.
Q. If a health plan specifically excludes conditions existing at the time when the insured’s coverage takes effect (pre-existing condition clauses), can the same rule apply to pregnancy existing at the time insurance coverage takes effect?
A. No. Pre-existing conditions cannot be applied to pregnancy, according to the Health Insurance Portability and Accountability Act of 1996. This is the case even if the woman had no prior coverage before enrolling in her employer's plan.
Q. If you offer employees a choice between enrolling in one of two health insurance plans, must both cover pregnancy-related conditions?
A. Yes. An employee with a single-coverage policy can’t be forced to purchase a family policy in order to be covered when she becomes pregnant.
Q. How must an employee be reimbursed for medical expenses incurred because of pregnancy-related conditions?
A. Again, the rule is that expenses arising from pregnancy must be reimbursed on the same basis as expenses for other medical conditions.
Q. Can you refuse to hire, discharge or in any other way discriminate against a woman for the sole reason that she’s had an abortion?
A. No. A woman who has had an abortion must be treated the same as other employees.
Q. If an abortion leads to complications, such as excessive hemorrhaging, must your health insurance plan cover the additional costs attributable to these complications?
A. Your plan must pay costs arising from complications resulting from an abortion—but not necessarily for the abortion itself.
Q. Can you decide to have your insurance program cover abortion, even if it’s not required?
A. The Pregnancy Discrimination Act specifically says that employers can provide insurance for abortion, either directly or through a collective bargaining agreement. However, employers are warned that if they do include abortion in their health insurance plan, they must do so in the same manner as they cover other medical conditions.
However, the debate surrounding the Affordable Care Act of 2010 revived the debate over abortion coverage, which has led to many states passing new laws limiting abortion coverage. You should check the law of your particular state for limits on abortion coverage. Since the enactment of the Affordable Care Act in March 2010, some 25 states have enacted legislation to restrict coverage for abortion in their insurance exchanges.
You can find more information at the National Conference on State Legislatures’ website. Visit http://www.ncsl.org and search for “abortion insurance.”
Final tip: Keep in mind that a pregnancy discrimination claim can’t succeed if there’s no evidence that the employer had knowledge of the pregnancy. (PrebilichHolland v. Gaylord, 6th Cir.)