|Self-Insured Plan; Caps on Drugs
Jun 2, 2001
Can an employer who has a self-insured health plan exclude certain kinds of conditions or put a cap on prescription drugs to treat HIV? I seem to recall that I have read that employers are able to do this in self-insured plans. However, isn't this a violation of the ADA (because this type of action is deemed to be discrimination against the employer in the context of his benefits?)
If this is permissible, then why don't self-insurance plans simply drop the most expensive prescription drugs, like HIV drugs?
| Response from Ms. Franzoi
Medical plans are not required to offer prescription drug coverage, unless they are insured plans and the coverage is required by state insurance law. Self-insured plans can put a cap on prescription drugs, including drugs related to a specific illness. Most employers who offer self-insured plans do not do this to avoid offering good health care coverage. They do this to avoid having different plan provisions in every state because each state has its own state insurance laws with different coverage requirements. It is a way for a multi-state company to have the same plan in every state. It also eliminates some of the cost for insurance such as retention, state premium taxes, etc. That is why most plans cover prescription drugs and do not put caps on the amount of coverage.
Get Email Notifications When This Forum Updates or Subscribe With RSS
- Hpv After Needle Stick Sign Of HIV AIDS
- Itchy Balls After Touching Sperm Sign Of HIV AIDS
- Pain In Urethra After Unprotected Vaginal Sex Worried I Have
- Painful Urination After Sucking Penis Worried I Have HIV
- Swollen Glands After Drinking Water Worried I Have HIV
- White Tongue After Insertive Oral Sex Worried I Have HIV
This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.
Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.