For example, it may be illegal for a health plan to cap benefits for the treatment of AIDS at a lower level than the cap applicable to the treatment of all other physical conditions. The lower AIDS cap would violate the ADA unless the disability-based distinction can be justified. Studies demonstrating that the cost of AIDS is comparable to the costs of other commonly covered conditions make it unlikely that this type of disparate treatment could be justified. Finally, even if a disability-based distinction is justified, a plan is rarely justified in completely denying coverage to an individual based on a diagnosis of disability. For example, a group plan generally could not deny coverage for treatments or procedures unrelated to the disability.
Justification is required only for disability-based distinctions.
Not all health-related plan distinctions discriminate on the basis of disability. The EEOC does not require justification of generally applicable limitations and exclusions, even if they adversely affect individuals with disabilities. Nor does the EEOC interpret the ADA to require that health plans make reasonable accommodation for individuals with disabilities. Employers, insurers and unions may continue to apply insurance distinctions that are not based on disability and are uniformly applied to all employees. The guidelines also permit facially neutral limitations such as lifetime coverage caps applied to all employees.