ABA Family Legal Guide

Law and the Workplace

On the Job

Discrimination in the Workplace

Must health insurance cover all medical expenses of an employee with a disability?

Not necessarily. Many insurance policies have preexisting condition clauses that disallow coverage for medical conditions that someone had before being employed by his or her current employer. Such clauses are lawful so long as they are not used as a subterfuge to evade the purposes of the ADA. Many health insurance policies also limit coverage for certain procedures or treatments to a specific number per year. For example, some provide reimbursement for only twelve psychiatric treatment sessions per year. Such limitations are generally allowed. It is not clear, however, whether an employer could offer a health insurance policy that puts a cap on the amount of reimbursement for a specific disease--for example, a $5,000 reimbursement limit for cancer--as opposed to a cap on the amount of reimbursement that is available for any type of medical condition--for example, a $1 million lifetime limit.