EEOC Press Release - June 9, 1993
U.S. Equal Employment Opportunity Commission

In announcing the suit, Chairman Tony E. Gallegos said, "Although there are several ADA-related insurance issues yet to be addressed through Commission guidance, the suit against Mason Tenders and the interim guidance issued yesterday focus on one specific issue -- the analysis necessary to determine whether disability-based distinctions in an employer-provided health insurance plan violate the ADA."

In this case, Mason Tenders District Council's Welfare Fund alerted plan participants in June 1991 to health insurance plan changes effective July 1, 1991. These changes included exclusion from coverage of "any expenses incurred for . . . the treatment of opportunistic infections (viral, fungal and bacterial), diseases and neoplasms resulting from the HIV infection (any type virus), Acquired Immune Deficiency Syndrome (AIDS) and/or AIDS related complex (ARC) ... .

Since the effective date of the amendment to the plan, the charging party, Terrence Donaghey, Jr., has been denied coverage under the Fund Plan for treatment of his HIV infection first diagnosed in 1989.

Under the interim policy guidance, once the Commission has determined that a challenged health insurance term or provision constitutes a disability-based distinction, the respondent must prove that the health insurance plan is both a bona fide plan and that the challenged distinction is not being used as a subterfuge for purposes of evading the ADA. For example, a disability-based exclusion could be a subterfuge if it is not justified by legitimate risk classification and underwriting procedures.

The Welfare Fund did not provide any evidence of an actuarial justification for the AIDS exclusion. Therefore, the Commission in its suit against Mason Tenders is asserting that the AIDS exclusion in the Fund Plan discriminates against individuals because of their disability, and not as a result of sound actuarial analysis.

EEOC enforces Title VII of the Civil Rights Act of 1964, which prohibits employment discrimination based on race, color, religion, sex or national origin; the Age Discrimination in Employment Act; the Equal Pay Act; prohibitions against discrimination affecting individuals with disabilities in the federal government; sections of the Civil Rights Act of 1991; and Title I of the Americans with Disabilities Act, which prohibits discrimination against people with disabilities in the private sector and state and local governments.