New regulations require mental health parity in insurance coverage
Government regs defining compliance with the new Mental Health Parity Act have finally come out, and there are a couple of important new points you need to know about.
Some things were already clear just from the Mental Health Parity law. Any employer of 50+ people that offers a plan with mental health/substance abuse benefits must:
- provide them at the same level as medical/surgical benefits, and
- drop any previous plan limits on mental health coverage.
The rules apply quantitative parity – how much treatment is allowed, what deductible is due – across six mental health benefit categories:
- inpatient in-network
- inpatient out-of-network
- outpatient in-network
- outpatient out-of-network
- emergency care
- prescription drugs.
In any of these classes, a health plan can’t apply a financial requirement or treatment limit to mental health/substance abuse benefits that’s tighter than the most common limit for “substantially all” medical/surgical benefits in that class. (“Substantially all” means at least two-thirds.)
The regs also require parity in non-quantitative treatment limits. These include medical management, standards to admit a provider to a network, and formulary design.
Example: An employee assistance program (EAP) can’t be a gatekeeper, restricting or directing mental health care, unless similar management is also used for medical/surgical benefits.
Also, employers can’t require employees to exhaust EAP benefits before they can access mental health care if a similar requirement does not exist for accessing other medical care.
You can find more at: www.millerjohnson.com
Subscribe to the Leadership Blog
Get the latest research on workplace learning with weekly posts delivered to your inbox