Q: Can a religious organization health plan gran non-covered services to one employee's dependent while denying it to other
The employer offers a uniform healthcare plan to all employees with a wellness benefit. When I joined the company I was told in no uncertain terms that the Plan Document Excludes any treatment for Developmental Disabilities including Autism. My wife spoke with customer services and a supervisor of the plan asking if speech or OT or ABA would be covered. She was directed to use Medi-Cal for ABA and any other therapy associated with my dependents' autism and told not to waste time with denials. Months later, I find out another employee who has been there forever,is getting full coverage for his autistic daughter for ABA, Speech, OT and any other therapy to treat her autism. The health plan has not changed nor the plan document. Other families with autistic children are getting denials for services and are being told to utilize Medi-Cal as well like my family. Is it OK or legal for this religious organization to offer services to one employee's autistic child and not to any others?
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. An attorney needs a full examination of all facts to give an opinion.
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