Under the Mental Health Parity and Addiction Equity Act, what must group health plans do for mental health and substance use disorder benefits?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
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.
Why the other options are wrong
- B) The parity law does not require excluding substance abuse treatment; if covered, such benefits must meet the same standards as medical benefits.
- C) Imposing a strict 10-visit cap while medical benefits have no similar limit would violate the parity requirement of equal treatment limits.
- D) The parity law applies to both outpatient and inpatient mental health and substance use disorder benefits, not only inpatient care.
Memory hook
Parity means the shrink's bill gets the same treatment as the surgeon's bill.