ABA Family Legal Guide

Health-Care Law

Health-Care Options

Health Insurance and Managed Care Organizations

Are health insurers and MCOs governed by state or federal law?

Each state makes its own laws as to what level of care health insurance and managed care must provide. Federal law limits the preexisting conditions that health-care insurers and plans may put into their policies.

The state laws are often similar to one another. More than half the states require health plans to pay for visits to the emergency room. Almost every state now requires that new mothers be allowed to stay in the hospital for at least forty-eight hours after giving birth.

However, if an employer-sponsored health plan is exempt under the Employee Retirement Income Security Act of 1974 (ERISA), as discussed in "Do you have access to external review?" below, then state and federal laws do not apply to the mandated coverage.