Consumer Questions and Answers about the Mental Health Parity
Act
Questions:
- My
plan has a limit of 30 visits per year on mental health benefits
and pays 80 percent of the provider's usual, customary, and
reasonable (UCR) charges. There is no similar visit limit on
medical and surgical benefits. Is this a violation of MHPA?
- I
am in a network plan that has an annual limit for mental health
benefits received out-of-network. There are no limits for
out-of-network medical and surgical benefits. Does MHPA allow
this?
- If
a State has a law that provides stronger protections for mental
health benefits than MHPA does, which law applies?
Answers:1) My plan has a limit of 30
visits per year on mental health benefits and pays 80 percent of the
provider's usual, customary, and reasonable (UCR) charges. There is
no similar visit limit on medical and surgical benefits. Is this a
violation of MHPA?
No. A visit limit
coupled with UCR charges is not the equivalent of an annual or
lifetime dollar limit. As a result, it is NOT a violation of the
MHPA requirements. Payments made by the plan on the basis of UCR
charges will vary from one case to the next.
2) I am in a network plan that
has an annual limit for mental health benefits received
out-of-network. There are no limits for out-of-network medical and
surgical benefits. Does MHPA allow this?
Yes. As long as there
is parity between medical and surgical benefits and mental health
benefits received in the network, then out-of-network limits do not
violate MHPA
3) If a State has a law that
provides stronger protections for mental health benefits than MHPA
does, which law applies?
Group health plans
generally are not subject to State insurance laws. State insurance
laws, however, do apply to health insurance issuers, and health
insurance issuers must comply with State insurance laws that provide
additional consumer protections. If a group health plan provides
health coverage to employees and their family members by purchasing
insurance for them, health insurance issuers may be required to
comply with State insurance laws that provide stronger protections
than MHPA. Click on the name of your State insurance department
under “Contacts” to find out who you should contact for additional
information.
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