What does the Mental Health Parity and Addiction Equity Act of 2008 do?
Generally, the Mental Health Parity and Addiction Equity Act (MHPAEA or “parity”) requires most health plans to apply similar rules to mental health and substance use disorder (MH/SUD) benefits as they do for medical/surgical benefits - otherwise known as “physical health” benefits.
WHAT IS MHPAEA?
We use “MHPAEA” to mean the Mental Health Parity and Addiction Equity Act of 2008.
WHAT IS MH/SUD?
MH/SUD stands for “Mental Health and Substance Use Disorder” benefits found in your health insurance plan.
WHAT ARE MEDICAL/SURGICAL BENEFITS?
These benefits include coverage for physical healthcare services.
What does Parity mean?
“Parity” means equality, or that something is the same as or equal to something else.
Parity here means that financial requirements, such as co-payments, and treatment limits, such as how many visits your insurance will pay for, must be comparable for physical health and MH/SUD services.
Parity also applies to rules related to how MH/SUD treatment is accessed and under what conditions treatment is covered such as whether you need permission from your health plan before starting treatment.
Here are some examples of common limits placed on physical and MH/SUD benefits and services that are subject to parity:
- Co-payments (or “co-pays”)
- Yearly visit limits
- Need for prior authorization
- Proof of medical necessity
Although benefits may differ across plans, parity requires that the processes related to plan benefit determinations be comparable.
What are the potential benefits of MHPAEA?
Here are examples of how the protections from this law may benefit you:
Plans must apply comparable co-pays for MH/SUD care and physical health care.
There can be no limit on the number of visits for outpatient MH/ SUD care, if there is no visit limit for outpatient physical health care.
Prior authorization requirements for MH/SUD services must be comparable to or less restrictive than those for physical health services.
Which health plans must comply with MHPAEA?
Most health plans are required by law to offer parity for MH/SUD benefits. Generally, these plans include most employer-sponsored group health plans and individual health insurance coverage, including coverage sold in the Health Insurance Marketplaces.
What information am I entitled to receive from my health plan?
With respect to parity, your health plan must provide information about the MH/SUD benefits it offers. You have the right to request this information from your health plan. This includes criteria the plan uses to decide if a service or treatment is medically necessary.
If your plan denies payment for MH/SUD services, your plan must give you a written explanation of the reason for the denial and must provide more information upon request.