State RegulationsPA specificDifficulty 2/5
A Pennsylvania group health insurer caps inpatient mental health days far below the inpatient days it allows for physical illnesses. A complaint alleges the plan violates Pennsylvania's parity requirements. Which statutory provisions govern this complaint?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Pennsylvania's mental health parity and addiction equity provisions are found at 40 P.S. §§ 908-11-908-16. These sections require that mental health benefits not be subjected to treatment less favorable than physical health benefits in the ways the parity law addresses — precisely the day-limit disparity described in the complaint. The serious mental illness mandate at 40 P.S. § 764g is a separate Pennsylvania requirement with its own subject matter.
Why the other options are wrong
- A) 40 P.S. § 1583 is the postpartum coverage mandate and has no bearing on mental health parity.
- B) 40 P.S. §§ 771-775.2 address newborn and adopted child coverage, not behavioral health parity.
- D) 40 P.S. §§ 3901-3909 mandate medical foods coverage, unrelated to parity requirements.
Memory hook
Parity lives in 908-11 through 908-16 — same article, later sections.