Information about the law that protects your mental health and addiction benefits. Read more about these protections here.
Mental Health Parity and Addiction Equity Act of 2008
Health benefits are physical health, mental health, and addiction services paid for by health insurance plans, often called “health insurance.” Generally, the Mental Health Parity and Addiction Equity Act (MHPAEA or “parity”) requires most health insurance plans to apply similar rules to mental health and addiction (Behavioral Health) benefits as they do for medical/surgical benefits – referred to here as “physical health” benefits.
Health Insurance Plans and Parity
Most health insurance plans are required by law to offer parity for Behavioral Health benefits. Generally, this includes employer-sponsored group health plans and individual health insurance coverage, including MassHealth plans.
What Parity Means to You
Parity means that financial requirements, such as copays, or how many visits your health insurance plan will pay for, must be comparable for physical health and behavioral health services. Parity also applies to rules related to how behavioral health treatment is accessed and under what conditions treatment is covered (such as whether you need prior authorization from your health plan before starting treatment).
Here are some examples of common limits placed on physical and behavioral health treatment services:
- Yearly visit limits
- Need for prior authorization
- Proof of medical necessity
Although health insurance benefits may differ, parity requires that the processes be comparable when accessing these benefits. Please call your health insurance plan to find out more information.
Here are examples of how the protections from this law may benefit you:
Plans must apply comparable copays for behavioral health care and physical health care.
There can be no limit on the number of visits for outpatient MH/SUD care if there is no visit limit for outpatient physical health care.
Prior authorization requirements for behavioral health services must be comparable to or less restrictive than those for physical health serv
If You Want to Learn More about Your Health Insurance Plan
If you have a health insurance plan through work, call your Human Resources (HR) rep for the “summary plan description” and the “summary of benefits and coverage.” You can usually find this number online or on the back of your health insurance card. You may also be able to check your health insurance plan benefits online to see what Behavioral Health Treatment services are covered.
Your Right to Information
Your health insurance plan will provide information to you about all the benefits it offers. You have the right to request this information from your health insurance plan. This includes criteria the plan uses to decide if a service or treatment is medically necessary. If your plan denies payment for MH/SUD services, your plan must give you a written explanation of the reason for the denial and must provide more information upon request.
Your Right to Appeal a Claim
If your health plan denies a claim, you have the right to appeal the denied claim. This means you can ask your health plan to look again at its decision, and perhaps reverse the decision and pay the claim. Call your health plan to ask how to submit a request to appeal a claim.
For more about the Federal parity law, go to the Department of Labor (DOL) Mental Health Parity page
or call toll-free at 1-866-444-3272 to speak to a DOL benefits advisor.
For assistance with parity issues in Massachusetts, please contact either the Massachusetts Division of Insurance at 1-877-563-4467, MassHealth at 1-800-841-2900, or the BSAS Helpline at https://helplinema.org/ or call at 1-800-327-5050 depending on your coverage.
For additional resources go to Substance Abuse and Mental Health Services Administration (SAMHSA) page and the Centers for Medicare & Medicaid Services (CMS) page.