Mental Health Parity

In 2008, Congress passed the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). According to the final rules, MHPAEA applies to certain group and individual health plans with plan years (or, in the individual market, policy years) on or after July 1, 2014.

Generally, MHPAEA requires that certain group and individual health plans which provide both mental health or substance use disorder (MH/SUD) benefits and medical or surgical (M/S) benefits to:

• Apply financial requirements or quantitative treatment limitations to MH/SUD benefits no more restrictively than the predominant financial requirement or treatment limitation that apply to substantially all M/S benefits in the same classification; and
• Apply nonquantitative treatment limitations to MH/SUD benefits comparably to and no more stringently than the limitations applied to M/S benefits in the same classification.

MHPAEA defines financial requirements to include deductibles, copays, coinsurance, and out of pocket limitations. Quantitative treatment limits might include number of visits or days of coverage allowed. Nonquantitative treatment limitations may be those things that limit the scope or duration of benefits such as medical necessity review, or the way a plan reviews an appeal.

Under the regulations, the above parity requirements are applied to MH/SUD and M/S benefits across each of the following classifications and sub-classifications:

• Inpatient, in-network,
• Inpatient, out-of-network,
• Outpatient, in-network,
  • Office visit
  • Other outpatient
• Outpatient, out-of-network,
  • Office visit
  • Other outpatient
• Emergency care, and
• Prescription drugs.

MHPAEA does not require plans to cover mental health or substance use disorders. However, the law generally applies if a plan covers both mental health or substance use conditions and medical or surgical conditions.

Where can I find more information about nonquantitative treatment limitations?

This information is coming soon. Please check back later to find an update about these limitations. In the meantime, if you have questions, please contact us.

The above information is a general overview of information related to health care plans. Your specific plan may have some differences. Content on this website is not intended to replace or amend language for any contract or coverage that you have with BCBSTX. You should always consult your plan documents and/or benefit brochure for details about what your health plan covers, as well as your rights and responsibilities under the plan. If you have questions about your specific plan, please contact us.

For more information, please visit Mental Health Parity and Addiction Equity Act