How to identify a discriminatory plan
Sometimes it is hard to spot a discriminatory plan. By its terms, a policy or plan may look like it does not discriminate against anyone but when the insurer administers the benefits to a category of people, it may impact them adversely based on their age, health condition, expected length of life, or one of the other prohibited bases already identified. Some examples include:
Imposing inappropriate age limits on services that are clinically effective at all ages – such as limiting coverage for a hearing aid to those who are 6 years old and younger although there may be older enrollees for whom a hearing aid is medically necessary.
Discouraging enrollment of individuals with chronic health needs – by placing most or all prescription drugs that treat a chronic condition in the highest cost tier, which could discourage people with those conditions from enrolling in health insurance.
Requiring a prior authorization for most or all medications in certain drug classes regardless of whether medical evidence supports this practice.
Excluding costly procedures from coverage such as bone marrow transplants even though they might be medically necessary for people with certain cancers and immune deficiency disorders.
Imposing higher cost-sharing amounts for individuals who use services such as emergency room visits more frequently, even though some patients have conditions such as asthma, heart failure or sickle cell anemia that commonly result in more frequent emergency room trips.
Only offering prescription drugs in the highest cost tier for some life-saving or life-prolonging drugs which have no generic equivalents or less expensive alternatives, which can discriminate against those, such as HIV/AIDS patients who require these drugs as a necessary treatment.
Limiting the number of visits a person may have for outpatient rehabilitation services without regard to best medical practices that may require more rehab services for particular conditions so that an individual can fully regain function.
There is no simple rule for determining whether a health insurance plan has designed essential health benefits in a discriminatory manner.
If you have health insurance coverage under an individual policy or small group plan that you think may discriminate against you on any of the bases identified on this website, please contact the Mississippi Insurance Department with your concerns.