Health Insurance Coverage of Mental Health Services
Under federal law, in most cases, health insurance providers must provide coverage for mental health and substance use disorders equivalent to the coverage they provide for medical/surgical care.
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.
If you have a concerns about your mental health coverage
For more information visit the Parity is Personal website
managed by theParity Implementation Coalition.
To report specific concerns about the Mental Health Parity Act and your insurance or to ask questions about how a group health plan may be implementing the law, send an email to email@example.com or call to leave a voice mail message (toll free) 866.882.6227. APA's Office of Healthcare Systems & Financing is monitoring compliance with the Mental Health Parity Act.
Along with a brief statement of the problem, your message should include your name and contact information (email/phone), the health plan's name, type of health plan (e.g., is it a group health plan, is it a self-funded health plan, etc.), the state where the insurance is issued, and whether the company employs 50 or fewer employees. Information provided to us will be held confidential.
Mental Health Parity and Addiction Equity Act of 2008 – Fact sheet from US Department of Labor.
Healthcare Reform - For information on the 2010 healthcare reform law, the Affordable Care Act, and what it means for you, visit www.healthcare.gov.