The Pregnancy Discrimination Act

At one time, pregnancy usually was treated differently from other medical conditions under both individual and group insurance policies. However, the Pregnancy Discrimination Act (a 1978 amendment to the Civil Rights Act) requires that women affected by pregnancy, childbirth, or related medical conditions be treated the same for employment-related purposes (including receipt of benefits under an employee benefit plan) as other persons who are not so affected but who are similar in their ability to work. The act applies only to the benefit plans (both insured and self-funded) of those employers who have 15 or more employees. While employers with fewer employees are not subject to the provisions of the act, they may be subject to comparable or more stringent state laws. Similarly, because the act applies only to employee benefit plans, pregnancy may be treated differently from other medical conditions under insurance policies that are not part of an employee benefit plan.

While the act itself is brief, enforcement falls under the jurisdiction of the EEOC, which has detailed guidelines for interpreting the act. The highlights of these guidelines are as follows:

If an employer provides any type of disability income or sick-leave plan for employees, the employer must provide coverage for pregnancy and its related medical conditions on the same basis as for other disabilities. For example, an employer cannot limit disability income benefits for pregnancies to a shorter period than that applicable to other disabilities.

If an employer provides medical expense benefits for employees, the employer must provide coverage for the pregnancy-related conditions of employees (regardless of marital status) on the same basis as for all other medical conditions.

If an employer provides medical expense benefits for dependents, the employer must provide equal coverage for the medical expenses (including those arising from pregnancy-related conditions) of spouses of both male and female employees. The guidelines also allow an employer to exclude pregnancy-related benefits for female dependents other than spouses as long as such an exclusion applies equally to the nonspouse dependents of both male and female employees.

Extended medical expense benefits after termination of employment must apply equally to pregnancy-related medical conditions and other medical conditions. Thus, if pregnancy commencing during employment is covered until delivery, even if the employee is not disabled, a similar nondisability extension of benefits must apply to all other medical conditions.

Medical expense benefits relating to abortions may be excluded from coverage except when the life of the woman is endangered. However, complications from an abortion must be covered. In addition, abortions must be treated like any other medical condition with respect to sick leave and other fringe benefit plans.