Mandated benefits (or also referred to as mandatory health insurance benefits and mandates) are legal requirements that a health insurance policy owner must procure in order to maintain his or her health coverage. These types of mandated benefits vary from state to state, but typically include preventative medical care benefits, coverage for certain types of therapies (e.g., chiropractic and physical therapy), mental health services, hospitalization benefits, disability income, and emergency services, among others. These are all services which are not covered by any preexisting condition.
One of the most important benefit mandates is hospitalization benefits, which cover costs incurred in receiving care. A medical emergency is defined as an inability to communicate with a doctor, make payments, or speaking properly due to a medical condition. This category includes emergency room visits, advanced procedures, and surgical operations. While in hospital, the insured may be entitled to receive a percentage of his or her total cost of treatment up to a specified limit after which deductions are made. Another important benefit is temporary disability benefits, which pay a percentage of lost wages to those injured on the job or traveling to get treatment, while workers compensation is designed to protect employees who suffer work-related injuries.
Many states require the purchase of an individual health insurance coverage by law, though the effective date varies from state to state. In many instances, the effective date will be one to two months post-receiving a notice from the insurance provider informing the insured that he or she qualifies for the benefit. The insurer may require the individual to purchase the insurance before the end of the mandated waiting period in certain states, though this is not always the case.