Authored By: Mental Health Association in Tulsa
- What illnesses must be covered?
- The legislation imposes no requirement as to what conditions must be covered. Treatment must be judged by a "medical necessity" standard. Companies must inform plan members what standards will be used to determine medical necessity and how to appeal that decision.
- Can insurance plans restrict mental health or addiction treatment?
- If mental health and substance abuse benefits are offered, coverage must be at parity with medical coverage. The law prohibits treatment limitations stricter than medical or surgical benefits, such as length of inpatient or outpatient hospital stays, emergency care services and office visits.
- Can insurance plans require greater financial expenses for mental health and substance abuse treatment?
- The law prohibits group health plans that offer coverage for mental health and substance-use conditions from imposing financial requirements on those benefits that are stricter than for medical and surgical benefits. This includes co-pays, co-insurance, deductibles and out-of-pocket expenses.
- Can group health plans restrict Out-of-Network coverage?
- If a plan offers out-of-network benefits for medical or surgical care, it must also offer out-of-network coverage for mental health and addiction treatment and provide services at parity.
- Does this impact Oklahoma's existing mental health parity laws?
- The federal law does not affect any state legislation that would supersede and require greater coverage.
- When does the Mental Health and Addiction Equality Act become effective?
- The effective date for all eligible group plans is the first plan year one year after the enactment of the law. If a health plan is under a collective bargaining agreement, the health plan must comply when it is renewedd, or by January 1, 2009.
- What plans are exempted?
- This law applies to health plans offered by employers, and is estimated to give greater benefits to 113 million Americans. However, any employer offering a group health plan with 50 or fewer employees, or any employer whose cost would increase more than 2% the initial year, or 1% in subsequent years is exempted from the requirements in this law.
Last Review and Update: Oct 30, 2008