Mental Health Parity

No more restrictive than the plan's medical and surgical benefits with respect to cost-sharing, limits, and coverage — The federal mental health parity requirements (MHPAEA) require group plans that offer mental health and substance use disorder benefits to make those benefits no more restrictive than medical and surgical benefits in financial requirements, such as deductibles, copayments, and coinsurance, and in treatment limitations, such as visit and day limits. Parity means equal treatment in coverage design, not a minimum mandated benefit or a fixed cap. The law is part of the legislative-impact cluster, including ERISA, COBRA, HIPAA, and mental health parity, under the federal anchors of the general concepts of medical and disability insurance (AH-III.B.4). Examiners test the equality standard rather than any specific day count.

National insurance concept

Apply financial requirements and treatment limits no more restrictive than those applied to medical and surgical benefits — The Mental Health Parity and Addiction Equity Act requires group health plans that offer mental health and substance use disorder benefits to apply the same financial requirements, such as deductibles, copayments, and coinsurance, and the same treatment limits, such as visit or day limits, that the plan applies to medical and surgical benefits. The parity test is comparative: mental health benefits cannot be more restrictive in cost-sharing or limits than the plan's medical and surgical benefits. The law does not force a plan to cover mental health, but if it does, the coverage must be on equal footing with medical care.

National insurance concept