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.
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