A Texas group health plan provides mental health and substance use disorder benefits. Which requirement applies to the financial requirements and treatment limitations it imposes on those benefits?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Mental health and substance use disorder services are essential health benefits under ACA Sections 1302 and 18022, and the parity requirement that travels with that status forbids a plan from applying financial requirements or treatment limitations to those benefits that are more restrictive than the predominant requirements applied to substantially all medical and surgical benefits. Separate or tighter dollar limits, higher copayments, or extra utilization controls aimed only at behavioral health are therefore prohibited, and annual and lifetime dollar limits may not be imposed on essential health benefits at all.
Why the other options are wrong
- A) The requirement comes from the federal essential health benefit and parity framework, not from whether a particular state mandates mental health coverage.
- B) A separate lifetime dollar limit on behavioral health benefits is prohibited; annual and lifetime dollar limits cannot be imposed on essential health benefits.
- D) Behavioral health treatment is an essential health benefit, so it cannot be singled out for higher copayments.
Memory hook
Parity means behavioral health plays by medical and surgical rules.