Metropolitan Life Insurance v. Massachusetts

471 U.S. 724, 105 S. Ct. 2380, 85 L. Ed. 2d 728, 1985 U.S. LEXIS 23, 6 Employee Benefits Cas. (BNA) 1545, 53 U.S.L.W. 4616, 119 L.R.R.M. (BNA) 2569
Supreme Court of the United States·Decided June 3, 1985·No. 84-325·Published·Cited by 1,637 cases

Opinion

*727 Justice Blackmun

delivered the opinion of the Court.

A Massachusetts statute requires that specified minimum mental-health-care benefits be provided a Massachusetts resident who is insured under a general insurance policy, an accident or sickness insurance policy, or an employee healthcare plan that covers hospital and surgical expenses. The first question before us in these cases is whether the state statute, as applied to insurance policies purchased by employee health-care plans regulated by the federal Employee Retirement Income Security Act of 1974, is pre-empted by that Act. The second question is whether the state statute, as applied to insurance policies purchased pursuant to negotiated collective-bargaining agreements regulated by the National Labor Relations Act, is pre-empted by the labor Act.

I

l>

General health insurance typically is sold as group insurance to an employer or other group. 1 Group insurance presently is subject to extensive state regulation, including *728 regulation of the carrier, regulation of the sale and advertising of the insurance, and regulation of the content of the contracts. 2 Mandated-benefit laws, that require an insurer to provide a certain kind of benefit to cover a specified illness or procedure whenever someone purchases a certain kind of insurance, are a subclass of such content regulation.

While mandated-benefit statutes are a relatively recent phenomenon, 3 statutes regulating the substantive terms of insurance contracts have become commonplace in all 50 States over the last 30 years. 4 Perhaps the most familiar are those regulating the content of automobile insurance policies. 5

*729 The substantive terms of group-health insurance contracts, in particular, also have been extensively regulated by the States. For example, the majority of States currently require that coverage for dependents continue beyond any contractually imposed age limitation when the dependent is incapable of self-sustaining employment because of mental or physical handicap; such statutes date back to the early 1960’s. 6 And over the last 15 years all 50 States have required that coverage of infants begin at birth, rather than at some time shortly after birth, as had been the prior practice in the unregulated market. 7 Many state statutes require that insurers offer on an optional basis particular kinds of coverage to purchasers. 8 Others require insurers either to offer or mandate that insurance policies include coverage for services rendered by a particular type of health-care provider. 9

Mandated-benefit statutes, then, are only one variety of a matrix of state laws that regulate the substantive content of health-insurance policies to further state health policy. Massachusetts Gen. Laws Ann., ch. 175, §47B (West Supp. 1985), is typical of mandated-benefit laws currently in place in the majority of States. 10 With respect to a Massachusetts *730 resident, it requires any general health-insurance policy that provides hospital and surgical coverage, or any benefit plan that has such coverage, to provide as well a certain minimum of mental-health protection. In particular, §47B requires that a health-insurance policy provide 60 days of coverage for confinement in a mental hospital, coverage for confinement in a general hospital equal to that provided by the policy for nonmental illness, and certain minimum outpatient benefits. 11

*731 Section 47B was designed to address problems encountered in treating mental illness in Massachusetts. The Commonwealth determined that its working people needed to be protected against the high cost of treatment for such illness. It also believed that, without insurance, mentally ill workers were often institutionalized in large state mental hospitals, and that mandatory insurance would lead to a higher incidence of more effective treatment in private community mental-health centers. See Massachusetts General Court, Joint Committee on Insurance, Advances in Health Insurance in Massachusetts (1974), reprinted in App. 426, 430-432.

In addition, the Commonwealth concluded that the voluntary insurance market was not adequately providing mental-health coverage, because of “adverse selection” in mental-health insurance: good insurance risks were not purchasing coverage, and this drove up the price of coverage for those who otherwise might purchase mental-health insurance. The legislature believed that the public interest required that it correct the insurance market in the Commonwealth by mandating minimum-coverage levels, effectively forcing the good-risk individuals to become part of the risk pool, and enabling insurers to price the insurance at an average market rather than a market retracted due to adverse selection. See Findings of Fact of the Superior Court, App. to Juris. Statement in No. 84-325, pp. 50a-53a. Section 47B, then, was intended to help safeguard the public against the high costs of comprehensive inpatient and outpatient mental-health care, reduce nonpsychiatric medical-care expenditures for mentally related illness, shift the delivery of treatment from inpatient to outpatient services, and relieve the Commonwealth of some of the financial burden it otherwise would encounter with respect to mental-health problems. Ibid.

*732 It is our task in these cases to decide whether such insurance regulation violates or is inconsistent with federal law.

B

The federal Employee Retirement Income Security Act of 1974, 88 Stat. 829, as amended, 29 U. S. C. § 1001 et seq. (ERISA), comprehensively regulates employee pension and welfare plans. An employee welfare-benefit plan or welfare plan is defined as one which provides to employees “medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability [or] death,” whether these benefits are provided “through the purchase of insurance or otherwise.” §3(1), 29 U. S. C. §1002(1). Plans may self-insure or they may purchase insurance for their participants. Plans that purchase insurance — so-called “insured plans”— are directly affected by state laws that regulate the insurance industry.

ERISA imposes upon pension plans a variety of substantive requirements relating to participation, funding, and vesting.

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Metropolitan Life Insurance v. Massachusetts, 471 U.S. 724, 105 S. Ct. 2380, 85 L. Ed. 2d 728, 1985 U.S. LEXIS 23, 6 Employee Benefits Cas. (BNA) 1545, 53 U.S.L.W. 4616, 119 L.R.R.M. (BNA) 2569 (1985).

471 U.S. 724 (Metropolitan Life Insurance v. Massachusetts) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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