Management News
Discrimination Based on Pregnancy, Childbirth, or Related Medical Conditions A. Introduction
B. Retirement Benefits
Employers must allow women who are on
pregnancy-related leaves to accrue seniority in the same way as those who are
on leave for reasons unrelated to pregnancy. Thus, if an employer allows
employees who take medical leave to retain their accumulated seniority and to
accrue additional service credit during their leaves, the employer must accord
the same treatment to women on pregnancy-related leaves. Similarly, employers
must treat pregnancy-related leaves the same as other medical leaves in
calculating the years of service that will be credited in evaluating an
employee's eligibility for a pension or for early retirement. C. Health Insurance Benefits
Health insurance plans offered in connection with
employment must cover pregnancy, childbirth, and related medical conditions in
the same way, and to the same extent, that they cover other medical conditions.
This means, in essence, two things: ·
an
employer's health insurance plan may not exclude coverage for pregnancy or
related medical conditions altogether; and ·
an
employer's health insurance plan must offer the same terms for coverage of
pregnancy, childbirth, and related medical conditions as for other medical
conditions. To offer coverage of pregnancy, childbirth, and
related medical conditions on the same terms as for other medical conditions,
an employer's health plan must provide for, among other things: ·
the
same deductibles; ·
the
same level of coinsurance payments; ·
the
same choices of physicians and hospitals; ·
the
same basis for reimbursement (e.g., by a flat dollar amount or by a percentage of
actual charges); and ·
the
same apportionment of charges for premiums between employer and employees. EXAMPLE - CP delivers her baby three weeks early while on
an out-of-state business trip. Employer J denies coverage of CP's hospital
charges because the delivery was not performed at a local hospital. Employer J
has violated the PDA if it typically covers costs incurred at non-local
hospitals when employees have medical emergencies away from home. EXAMPLE - Employer Q denies coverage of any expenses
related to CP's pregnancy on the ground that her date of conception predated
her enrollment in the insurance plan. If Employer Q excludes coverage for all
conditions that commenced before an individual's date of coverage by the plan,
this will not violate the PDA. EXAMPLE - Employer U's policy states that it will not
cover routine sonograms during the course of a pregnancy. The investigator
should determine how Employer U handles claims for other routine diagnostic
procedures. If, for example, Employer U does cover the cost of routine dental
X-rays or PAP smears, it must cover sonograms to a comparable extent |
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Under the Pregnancy Discrimination Act (PDA),
women who are affected by pregnancy, childbirth or related medical conditions
must be treated the same as others who are similarly able or unable to work.
Where an employer offers benefits of any sort, therefore -- including
retirement, health insurance, or disability benefits -- it must cover pregnancy
and related medical conditions in the same way, and to the same extent, that it
covers other medical conditions.