State Employee Health Plan Obesity Treatment Coverage 2020-21

In 2021, the STOP Obesity Alliance conducted a state-by-state analysis of State Employee Health Plan (SEHP) health care coverage for plan year 2020/2021 for obesity prevention and treatment, including preventive services and counseling, nutrition counseling, drug therapy, and bariatric surgery.

State data include: (1) Prevalence of obesity from the 2019 Behavioral Risk Surveillance System - data for 2019 are the latest published data available at the time of this coverage review. (2) The red/yellow/green colors on the map reflect each state's publicly available plan documents for coverage of four treatment categories: preventive services and counseling, nutrition counseling, drug therapy, and bariatric surgery. To determine whether a service was covered, plan documents were reviewed for language that addressed coverage, conditions of coverage, and exclusions from coverage. Color scores were assigned based on the number of treatment categories for which coverage was indicated (red = 0-1; yellow = 2-3; green = 4).

If a plan included both a general exclusion for obesity related services but also a specific provision indicating coverage for a particular cate gory of services, the category was considered to be covered. Example: if a plan included a general exclusion for all obesity related services but included a specific provision outlining criteria for bariatric surgery, the plan was considered to offer coverage for bariatric surgery.
If a state offered multiple plans to employees, each plan was reviewed. Although substantive differences in coverage terms were limited, the most generous plan, according to the metrics of this review, was reported.
If a plan indicated coverage for drug therapy, either by naming specific covered drugs or indicating coverage for drugs as a class, the plan was considered to offer coverage for drug therapy. In this review, a plan that covers a single drug for weight loss was coded the same way as a plan that covered drugs for weight loss as a drug class.
We did not probe the plans coverage to identify the duration of benefits like counseling, the specific drugs that were covered, or whether copays or other criteria might pose barriers to the utilization of these benefits.

Sliding Backwards in Obesity Care

STOP State Employee Health Plan research selected as Editors' Choice in Obesity finds that multiple states have reduced or plateaued in offering obesity prevention and treatment services for employees.

Read the Obesity article

State-by-State Sources

Read 2024 State Medicaid Obesity Treatment Coverage Read the 2016/2017 State Medicaid and SEHP Publication