Q: Are religious organization health plans subject to 26 CFR section 54.9802-1 Prohibition of Discrimination Requirements?
The plan states in its Plan Document "any therapy or service for a developmental disability/DD is a non-covered service under the plan". When consulting with customer service & doctors who are providers in the plan, members are told that services for DD dependents are excluded from coverage if they are due to the DD period. However, some dependents of certain employees in the same health plan are receiving these non-covered therapies as covered benefits for the same DD condition while they are being denied (or claims suppressed) to others. Is it legal for this employer to offer and fully cover non-covered therapy services for DD of one employee's DD dependent child, while denying the same services to other similarly situated DD dependent children of employees of the company enrolled in the same health plan? Is this religious employer exempt from 26 CFR Section 54.9802-1 prohibiting discrimination requirements or is this discrimination?
A: I'm pretty sure that religious organizations are exempt from the requirements relating to discrimination in this context. The rules allow them to discriminate, period, and I can't think of a single legal remedy that might be available to you. Nonetheless, even if they can legally discriminate in this context, it doesn't make it morally right. Perhaps you can use the collective conscience of your peers to condemn such immoral practices, but legally speaking, filing suit will get you nothing but unnecessary stress, expense and aggravation.
A: Ok, so this is a health plan provided by a religious organization acting in the capacity of an employer. While religious organizations are granted a lot of leeway in choosing benefits within the scope of the practices of the faith, they are still prohibited from other types of discrimination. What you describe could be a violation of ERISA because the employer provided health plan is an employee benefit possibly covered by ERISA. You need to consult with an ERISA attorney or an attorney that practices in the area of insurance benefits/ health plans/ wrongful denial of benefits. It does not sound correct that some employees get the benefits and others do not unless there are possibly Executive plans.
Justia disclaimers below, incorporated herein.
Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.
The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.
Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.