Insurance and Parity

Health Insurance Coverage for
Mental Health Services

Under federal law, in most cases, health insurance providers
must provide coverage for mental health and substance use
equivalent to the coverage they provide for medical care.

A new poster from APA, Fair Insurance Coverage:  Its the Law, 
explains patient rights for mental health and addiction care coverage and how to report unfair practices. Reporting possible violations can
help regulators enforce the law and help end discrimination in mental health care coverage. 

If you have a concerns about your health plan's compliance with federal law:

  • Contact the federal government’s Center for Consumer Information and Insurance Oversight (CCIIO) at 877-267-2323
    or email phig@cms.hhs.com
  • Contact a benefit advisor at the U.S. Department of Labor at or www.askebsa.dol.gov
  • Call your state insurance commissioner’s office (search state list)

Parity poster image New Poster explains patient rights
for mental health coverage
under federal law
Download the poster

             

Health
Insurance
Marketplace

 healthcare.gov 

 
Former Congressman Patrick Kennedy,
Healthy Minds Minute PSA


Brief Look at the Law

The Mental Health Parity and Addiction Equity Act of 2008 requires that if mental health/substance use disorder benefits are provided, they must be no more restrictive than those that apply to medical/surgical benefits, including:

    - Financial requirements – e.g., deductibles and co-payments
    - Treatment limitations – e.g., number of visits or days of coverage
    - Out of network benefits

The law does not require inclusion of mental health or substance use disorder benefits.

The law Applies to:     Large groups health plans (self-funded and fully insured)

Does not apply to: Small group health plans (2 – 50 employees) and individual market health coverage

For most health plans, the law went into effect January 1, 2010. It requires that insurers provide, upon request, explanation of the standards for medical necessity determinations and reasons for any denial of benefits relating to MH/SUD benefits.

 

More Information



Parity is Personal website managed by the Parity Implementation Coalition.

Parity and psychiatry - information and resources for APA members

APA actions and positions - Information on legislative and regulatory issues and APA actions

Fact sheet from US Department of Labor:  Mental Health Parity and Addiction Equity Act of 2008

Affordable Care Act and Health Insurance Marketplace   www.healthcare.gov.