COMPLIANCE ALERT: Mental Health and Substance Use Disorder Benefits—Parity Requirements

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires parity between a group health plan’s medical and surgical benefits and its mental health or substance use disorder (MH/SUD) benefits. In general, if a health plan provides MH/SUD benefits, MHPAEA requires the plan to:

• Offer the same access to care and patient costs for MH/SUD benefits as those that apply to medical/surgical benefits;
• Treat MH/SUD coverage and medical/surgical coverage equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review; and
• Contain a single combined deductible for MH/SUD coverage and medical/surgical coverage.

MHPAEA’s parity requirements apply to group health plans sponsored by employers with more than 50 employees. However, due to an Affordable Care Act (ACA) reform, insured health plans in the small group market must also comply with federal parity requirements for MH/SUD benefits.