Most people in the U.S. have health insurance coverage , typically
provided by your employer . Historically , many health insurance plans
provided less coverage for mental health services compared to physical
health services ( medical / surgical ) . For example , a health plan may
cover only 50 percent of the costs associated with seeing a
psychologist , but 80 percent of the costs associated with seeing a
primary care physician .
To help end discriminatory insurance coverage of using mental health services and Congress passed the Wellstone - Domenici Mental Health Parity and Addiction Equity Act ( MHPAEA ) in 2008 . This question - and answer guide explains how federal law affects This historical coverage of substance abuse services and mental health.
What is the Mental Health Parity and Equality Law in addiction ?
The Mental Health Parity and Equality Act or MHPAEA addiction , requires private health insurance plans to provide equal coverage for mental health and physical health. MHPAEA Congress approved for adults and children who suffer from mental health disorders , such as anxiety and depression and substance use disorders , : such as those related to alcohol - use , would have better access to needing treatment .
When MHPAEA take effect ?
The law took effect on January 1, 2010 . The following month, the federal government issued a standard that provides guidance for group health insurance plans on how to meet MHPAEA . For most health plans affected by the federal parity law , federal law concerning MHPAEA commence on January 1, 2011 .
Does the law apply to my health insurance plan ?
The law applies to all health insurance plans for more than 50 employees that provide benefits of use or mental health disorder as part of the plan. Lower MHPAEA does not apply to health plans or Medicare. The plans of the employees of state and local government can opt for federal parity law , although some of these plans have been made. Importantly plans 50 or fewer employees are subject to the requirements of the laws of mental health parity state.
Will my health plan MHPAEA needed to provide mental health benefits ?
MHPAEA does not require private health insurance plans that include mental health benefits . However , almost all health plans sponsored by the employer in the United States include these important benefits .
Is likely to stop providing mental health benefits as a result of MHPAEA my employer ?
Employers are very unlikely to do so. 2010 survey by the Kaiser Family Foundation ' s health coverage that is less than 2 percent of companies with more than 50 employees - which applies MHPAEA - insurance coverage mental health declined due to federal law .
What does " health and substance use parity mental "?
Mental health and substance use parity That means benefits coverage for substance abuse and mental health must be at least equal to the coverage of physical health benefits . In other words , all financial requirements and treatment limitations applied to the benefits of substance use and mental health and can not be more restrictive than those applied to physical health benefits .
Financial requirements include lifetime limits and annual dollar deductibles, copayments, coinsurance and expenses out of pocket maximum . Treatment limitations include the frequency of treatment , number of visits , days of coverage and other similarly limits .
What kind of financial requirements and treatment limitations are prohibited by MHPAEA ?
A health plan can not place a financial requirement or treatment limitation in substance abuse and mental health benefits unless the same limit is placed on the physical health benefits .
For example, a plan covered by MHPAEA not be applied to the 20 visit annual limit to see a psychologist , but there is a limit to see a doctor . If annual visits to the doctor's office are not limited annual visits to a psychologist 's office can not be limited.
Another example : a patient may not be required to pay a copayment of $ 50 for a psychotherapy session , but only a copayment of $ 20 per office visit to a doctor . The patient ' s out - of - pocket expenses should be the same for both visits .
A health insurance company must tell me what has been denied an insurance claim ?
An insurance company denying a claim may for a variety of reasons. A common reason is that health plans only pay for the services that they consider to be " medically necessary." MHPAEA Requires insurance plans to make their medical necessity criteria available to current or potential participants . A health plan must inform participants why a claim has been denied , decisions acerca Whether by necessity or for other reasons.
MHPAEA Is A Certain limited to the coverage of mental health diagnoses ?
No. MHPAEA excludes no mental disorders, substance use diagnoses. Under federal law , parity requirements apply to all services covered by a health plan .
MHPAEA does not prohibit a health plan to deny coverage for diagnostic use of individual mental health disorders or . Although not a common practice in the health plan coverage for individual diagnoses can reject as specified in the terms of its contract with employer coverage .
Does it apply MHPAEA services outside the network ?
Yes When people have access to the " off the grid " ( OON ) through their health plan services , means that they also receive care providers of health: as psychologists and physicians who do not participate in the provider network health plan ' s . If a health plan must comply with MHPAEA that provides both Oon use disorder benefits health / physical and mental substance , these benefits must be provided to the couple . If the plan provides special benefits available only to medical / surgical services , the parity law requires the plan to add OON mental health and substance use disorder benefits , at par.
What should I do if I think my health plan may not be complying with MHPAEA ?
Talk to human resources staff or other employee in your company or organization that oversees the health insurance plan . You can also contact a representative of the insurance company that administers the health plan to raise their questions and concerns. Also, you have the option of filing a formal complaint with the federal government . Complaints acerca insurance plans regulated by state law may be made through a toll - free Department of Health and Human Services Hotline at (877) 267-2323 , ext . 61565 . For plans " self-funded " ERISA governed by federal law known as (generally those of large employers ) that contact the Department of Labor at ( 866 ) 444-3272 .
To help end discriminatory insurance coverage of using mental health services and Congress passed the Wellstone - Domenici Mental Health Parity and Addiction Equity Act ( MHPAEA ) in 2008 . This question - and answer guide explains how federal law affects This historical coverage of substance abuse services and mental health.
What is the Mental Health Parity and Equality Law in addiction ?
The Mental Health Parity and Equality Act or MHPAEA addiction , requires private health insurance plans to provide equal coverage for mental health and physical health. MHPAEA Congress approved for adults and children who suffer from mental health disorders , such as anxiety and depression and substance use disorders , : such as those related to alcohol - use , would have better access to needing treatment .
When MHPAEA take effect ?
The law took effect on January 1, 2010 . The following month, the federal government issued a standard that provides guidance for group health insurance plans on how to meet MHPAEA . For most health plans affected by the federal parity law , federal law concerning MHPAEA commence on January 1, 2011 .
Does the law apply to my health insurance plan ?
The law applies to all health insurance plans for more than 50 employees that provide benefits of use or mental health disorder as part of the plan. Lower MHPAEA does not apply to health plans or Medicare. The plans of the employees of state and local government can opt for federal parity law , although some of these plans have been made. Importantly plans 50 or fewer employees are subject to the requirements of the laws of mental health parity state.
Will my health plan MHPAEA needed to provide mental health benefits ?
MHPAEA does not require private health insurance plans that include mental health benefits . However , almost all health plans sponsored by the employer in the United States include these important benefits .
Is likely to stop providing mental health benefits as a result of MHPAEA my employer ?
Employers are very unlikely to do so. 2010 survey by the Kaiser Family Foundation ' s health coverage that is less than 2 percent of companies with more than 50 employees - which applies MHPAEA - insurance coverage mental health declined due to federal law .
What does " health and substance use parity mental "?
Mental health and substance use parity That means benefits coverage for substance abuse and mental health must be at least equal to the coverage of physical health benefits . In other words , all financial requirements and treatment limitations applied to the benefits of substance use and mental health and can not be more restrictive than those applied to physical health benefits .
Financial requirements include lifetime limits and annual dollar deductibles, copayments, coinsurance and expenses out of pocket maximum . Treatment limitations include the frequency of treatment , number of visits , days of coverage and other similarly limits .
What kind of financial requirements and treatment limitations are prohibited by MHPAEA ?
A health plan can not place a financial requirement or treatment limitation in substance abuse and mental health benefits unless the same limit is placed on the physical health benefits .
For example, a plan covered by MHPAEA not be applied to the 20 visit annual limit to see a psychologist , but there is a limit to see a doctor . If annual visits to the doctor's office are not limited annual visits to a psychologist 's office can not be limited.
Another example : a patient may not be required to pay a copayment of $ 50 for a psychotherapy session , but only a copayment of $ 20 per office visit to a doctor . The patient ' s out - of - pocket expenses should be the same for both visits .
A health insurance company must tell me what has been denied an insurance claim ?
An insurance company denying a claim may for a variety of reasons. A common reason is that health plans only pay for the services that they consider to be " medically necessary." MHPAEA Requires insurance plans to make their medical necessity criteria available to current or potential participants . A health plan must inform participants why a claim has been denied , decisions acerca Whether by necessity or for other reasons.
MHPAEA Is A Certain limited to the coverage of mental health diagnoses ?
No. MHPAEA excludes no mental disorders, substance use diagnoses. Under federal law , parity requirements apply to all services covered by a health plan .
MHPAEA does not prohibit a health plan to deny coverage for diagnostic use of individual mental health disorders or . Although not a common practice in the health plan coverage for individual diagnoses can reject as specified in the terms of its contract with employer coverage .
Does it apply MHPAEA services outside the network ?
Yes When people have access to the " off the grid " ( OON ) through their health plan services , means that they also receive care providers of health: as psychologists and physicians who do not participate in the provider network health plan ' s . If a health plan must comply with MHPAEA that provides both Oon use disorder benefits health / physical and mental substance , these benefits must be provided to the couple . If the plan provides special benefits available only to medical / surgical services , the parity law requires the plan to add OON mental health and substance use disorder benefits , at par.
What should I do if I think my health plan may not be complying with MHPAEA ?
Talk to human resources staff or other employee in your company or organization that oversees the health insurance plan . You can also contact a representative of the insurance company that administers the health plan to raise their questions and concerns. Also, you have the option of filing a formal complaint with the federal government . Complaints acerca insurance plans regulated by state law may be made through a toll - free Department of Health and Human Services Hotline at (877) 267-2323 , ext . 61565 . For plans " self-funded " ERISA governed by federal law known as (generally those of large employers ) that contact the Department of Labor at ( 866 ) 444-3272 .
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