Mental Health Parity Act Statutory Text
UNITED STATES CODE SERVICE
TITLE 42. THE PUBLIC HEALTH AND WELFARE
CHAPTER 6A. THE PUBLIC HEALTH SERVICE
REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
GROUP MARKET REFORMS; OTHER REQUIREMENTS (42 USCS § 300gg-5)
(1999)
§ 300gg-5. Parity in the application of certain limits to mental
health benefits
(a) In general. (1) Aggregate
lifetime limits. In the case of a group health plan (or health
insurance coverage offered in connection with such a plan) that
provides both medical and surgical benefits and mental health
benefits--
(A)
No lifetime limit. If the plan or coverage does not include an
aggregate lifetime limit on substantially all medical and surgical
benefits, the plan or coverage may not impose any aggregate lifetime
limit on mental health benefits.
(B)
Lifetime limit. If the plan or coverage includes an aggregate
lifetime limit on substantially all medical and surgical benefits
(in this paragraph referred to as the "applicable lifetime limit"),
the plan or coverage shall either--
(i)
apply the applicable lifetime limit both to the medical and surgical
benefits to which it otherwise would apply and to mental health
benefits and not distinguish in the application of such limit
between such medical and surgical benefits and mental health
benefits; or
(ii) not include any aggregate lifetime limit on mental health
benefits that is less than the applicable lifetime limit.
(C)
Rule in case of different limits. In the case of a plan or coverage
that is not described in subparagraph (A) or (B) and that includes
no or different aggregate lifetime limits on different categories of
medical and surgical benefits, the Secretary shall establish rules
under which subparagraph (B) is applied to such plan or coverage
with respect to mental health benefits by substituting for the
applicable lifetime limit an average aggregate lifetime limit that
is computed taking into account the weighted average of the
aggregate lifetime limits applicable to such categories.
(2) Annual limits. In the case of
a group health plan (or health insurance coverage offered in
connection with such a plan) that provides both medical and surgical
benefits and mental health benefits--
(A)
No annual limit. If the plan or coverage does not include an annual
limit on substantially all medical and surgical benefits, the plan
or coverage may not impose any annual limit on mental health
benefits.
(B)
Annual limit. If the plan or coverage includes an annual limit on
substantially all medical and surgical benefits (in this paragraph
referred to as the "applicable annual limit"), the plan or coverage
shall either--
(i) apply the applicable annual limit both to medical and surgical
benefits to which it otherwise would apply and to mental health
benefits and not distinguish in the application of such limit
between such medical and surgical benefits and mental health
benefits; or
(ii) not include any annual limit on mental health benefits that is
less than the applicable annual limit.
(C)
Rule in case of different limits. In the case of a plan or coverage
that is not described in subparagraph (A) or (B) and that includes
no or different annual limits on different categories of medical and
surgical benefits, the Secretary shall establish rules under which
subparagraph (B) is applied to such plan or coverage with respect to
mental health benefits by substituting for the applicable annual
limit an average annual limit that is computed taking into account
the weighted average of the annual limits applicable to such
categories.
(b) Construction. Nothing in this section shall be construed--
(1) as requiring a group health
plan (or health insurance coverage offered in connection with such a
plan) to provide any mental health benefits; or
(2) in the case of a group health
plan (or health insurance coverage offered in connection with such a
plan) that provides mental health benefits, as affecting the terms
and conditions (including cost sharing, limits on numbers of visits
or days of coverage, and requirements relating to medical necessity)
relating to the amount, duration, or scope of mental health benefits
under the plan or coverage, except as specifically provided in
subsection (a) (in regard to parity in the imposition of aggregate
lifetime limits and annual limits for mental health benefits).
(c) Exemptions. (1) Small
employer exemption. This section shall not apply to any group health
plan (and group health insurance coverage offered in connection with
a group health plan) for any plan year of a small employer.
(2) Increased cost exemption.
This section shall not apply with respect to a group health plan (or
health insurance coverage offered in connection with a group health
plan) if the application of this section to such plan (or to such
coverage) results in an increase in the cost under the plan (or for
such coverage) of at least 1 percent.
(d) Separate application to each option offered. In the case of a
group health plan that offers a participant or beneficiary two or
more benefit package options under the plan, the requirements of
this section shall be applied separately with respect to each such
option.
(e) Definitions. For purposes of this section--
(1) Aggregate lifetime limit. The
term "aggregate lifetime limit" means, with respect to benefits
under a group health plan or health insurance coverage, a dollar
limitation on the total amount that may be paid with respect to such
benefits under the plan or health insurance coverage with respect to
an individual or other coverage unit.
(2) Annual limit. The term
"annual limit" means, with respect to benefits under a group health
plan or health insurance coverage, a dollar limitation on the total
amount of benefits that may be paid with respect to such benefits in
a 12-month period under the plan or health insurance coverage with
respect to an individual or other coverage unit.
(3) Medical or surgical benefits.
The term "medical or surgical benefits" means benefits with respect
to medical or surgical services, as defined under the terms of the
plan or coverage (as the case may be), but does not include mental
health benefits. (4) Mental
health benefits. The term "mental health benefits" means benefits
with respect to mental health services, as defined under the terms
of the plan or coverage (as the case may be), but does not include
benefits with respect to treatment of substance abuse or chemical
dependency.
(f) Sunset. This section shall not apply to benefits for services
furnished on or after September 30, 2001.
HISTORY: (Sept. 26, 1996, P.L. 104-204, Title VII, § 703(a), 110
Stat. 2947.)
HISTORY; ANCILLARY LAWS AND DIRECTIVES
Other provisions:
Applicability of section. Act Sept. 26, 1996, P.L. 104-204, Title
VII, § 703(b), 110 Stat. 2950, provides: "The amendments made by
this section [adding this section] shall apply with respect to group
health plans for plan years beginning on or after January 1,
1998.".
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