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Experimental Metastasis Assay
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State legislative approaches to regulating coverage for experimental procedures.

M E Reagan

    Health Care Law Newsletter
    |August 6, 1994
    PubMed
    Summary
    This summary is machine-generated.

    State regulation of group health plans is limited by the Employment Retirement Income Security Act (ERISA). ERISA prevents states from mandating coverage for self-insured plans, impacting experimental treatment insurance access.

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    Area of Science:

    • Health Law
    • Employee Benefits Law
    • Insurance Regulation

    Background:

    • The Employment Retirement Income Security Act (ERISA) preempts state laws concerning employee benefit plans.
    • States have limited authority to mandate specific health coverages for self-insured group health plans.
    • Past legal challenges and legislative efforts highlight inconsistencies in experimental treatment coverage.

    Purpose of the Study:

    • To analyze the impact of ERISA on state regulation of group health plan coverage.
    • To examine the challenges in ensuring consistent insurance coverage for experimental treatments.
    • To assess the effectiveness of state legislative attempts to regulate health insurance mandates.

    Main Methods:

    • Legal analysis of ERISA preemption provisions.
    • Review of relevant case law, including Metropolitan Life Ins. Co. v. Massachusetts.
    • Examination of state legislative trends regarding health insurance mandates.

    Main Results:

    • ERISA significantly restricts states from imposing coverage mandates on self-insured health plans.
    • State mandates are primarily enforceable against insurance companies and HMOs, not self-insured employers.
    • Legislative efforts to regulate experimental treatment coverage have largely focused on non-self-insured plans.

    Conclusions:

    • State attempts to mandate experimental treatment coverage are limited by ERISA's scope.
    • A legislative amendment to ERISA is necessary to extend protections to employees with self-insured plans.
    • Inconsistent coverage for experimental treatments will persist without federal intervention for self-insured plans.