The U.S. Equal Employment Opportunity Commission

EEOC Office of Legal Counsel staff members wrote the following informal discussion letter in response to an inquiry from a member of the public. This letter is intended to provide an informal discussion of the noted issue and does not constitute an official opinion of the Commission.


Definition of "Disability" - Obesity; Health Insurance and Other Benefits

November 4, 1999

Dear

This responds to your inquiry of October 6, 1999, about the Americans with Disabilities Act of 1990 (ADA). You asked whether a health insurance plan provision that excludes coverage for treatments for obesity or weight reduction violates the ADA.

The EEOC enforces the Title I employment provisions of the ADA, which prohibit covered employers from discriminating against qualified individuals with disabilities on the basis of disability. To be protected by the ADA, an individual must meet the ADA definition of "disability."

The ADA defines "disability" as a physical or mental impairment that substantially limits a major life activity (such as walking, breathing, learning, or working), a record of such an impairment, or being regarded as having such an impairment. "Substantially limits" means that an impairment prevents a person from performing a major life activity or significantly restricts the person's ability to perform the activity as compared to the ability of the average person in the general population. The EEOC has stated that morbid obesity is an impairment, but this does not mean that it is a disability. Whether a person with morbid obesity has a disability depends on whether that particular person is substantially limited in a major life activity, has a history of being substantially limited, or is regarded as being substantially limited.

The ADA's prohibition against employment discrimination includes discrimination in the provision or administration of fringe benefits, such as employer-provided health or life insurance. Thus, the ADA generally requires that individuals with disabilities be accorded equal access to whatever health insurance is provided to individuals without disabilities.

On the other hand, section 501(c) of the ADA specifically permits employers and insurance companies to continue to use legitimate risk assessment and other traditional insurance classification and administration practices, as long as the practices are uniformly applied to all insureds and are not used as a subterfuge to evade the purposes of the ADA.

In an Interim Enforcement Guidance issued on June 8, 1993, the Commission explained how these ADA requirements apply to the terms of employer-provided health insurance plans.

Interim Enforcement Guidance on the application of the Americans with Disabilities Act of 1990 to disability-based distinctions in employer provided health insurance (1993) (copy enclosed). Plan limitations or distinctions that are not disability based do not violate the ADA so long as they are applied equally to all insureds. Such limitations are permissible, even if they have a greater effect on some people with disabilities, because they apply to and constrain insureds both with and without disabilities. Guidance at 5-7.

By contrast, health insurance plan limitations or distinctions that are disability based may violate the ADA. A distinction is disability based if it singles out a particular disability (e.g., deafness, AIDS, schizophrenia), a discrete group of disabilities (e.g., cancers, muscular dystrophies, kidney diseases), or disability in general (e.g., all impairments that substantially limit a major life activity). Id. at 7. Such a distinction violates the ADA unless the employer can show that it is part of a bona fide insurance plan and is not used as a subterfuge to evade the purposes of the ADA. Id. "Subterfuge" means that the distinction is not justified by the particular risks or costs associated with a disability. Id. at 11. An employer can defend a disability-based distinction in a plan by showing, for example, that it is necessary to prevent a drastic change in the scope or cost of the plan or that it is justified by actual or reasonably anticipated experience. Id. at 11-13.

Thus, a determination of whether a provision in an employer-provided health insurance plan that excludes or limits coverage for the treatment of obesity or for weight reduction violates the ADA requires a fact-specific inquiry into the precise provision and the employer's justification for it.

This letter is an informal discussion of the issues you raised and does not constitute an official opinion of the Equal Employment Opportunity Commission. In addition, our silence on other matters that may have been presented in your letter should not be construed as agreement with those matters.

Sincerely,

Christopher J. Kuczynski
Assistant Legal Counsel
ADA Policy Division

Enclosure


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