Mental health parity
The Mental Health Parity and Addiction Equity Act of 2008 ensures Americans have access to non-discriminatory mental health and substance abuse coverage through their health insurance plans.
Who it impacts
- Mental health parity applies to plans with more than 50 employees, whether they are fully funded, self-funded, or employer-sponsored Medicare groups.1
- Small groups of 50 employees or less are exempt.
- Individual plans are exempt.
If mental health parity applies to your group, make sure your agent knows about it.
What the act requires
The law requires parity in financial limits, treatment limits and out-of-network provider access between behavioral health benefits (mental health/substance use disorders) and medical/surgical benefits:
- Financial limits - equity in deductibles, copays, coinsurance, out-of-pocket limits, lifetime limits, and annual limits
- Treatment limits - equity in limits on the frequency of treatment, number of visits, days of coverage or other similar limits on the scope or duration of treatment
- Out-of-network coverage - equity between out-of-network coverage for medical/surgical benefits and behavioral health benefits
A group health plan can still manage the benefits under the terms and conditions of the plan, including medical necessity criteria. The law also doesn't mandate that all behavioral health conditions are covered; it only requires coverage of conditions as defined under the terms of each plan.
