Mental Health and Substance Abuse Rights: What Employers Need to Know

Employees are increasingly aware of their rights to mental health and substance abuse treatment through employer-sponsored health plans. Are you aware of what your plan needs to do? Below are resources to help.

Mental Health and Substance Abuse Rights: What Employers Need to Know
The U.S. government is educating individuals on the Mental Health Parity and Addiction Equity Act (MHPAEA). Plan sponsors can look over these consumer resources to see what the government and informed employees expect.

Consumer/Employee Resources:
Know Your Rights: Parity for Mental Health and Substance Use Disorder Benefits – Substance Abuse and Mental Health Services Administration (SAMHSA)
Mental Health and Addiction Insurance Help: Do you have insurance questions about mental health or addiction services? – Department of Health and Human Services (HHS)
Consumer Guide to Disclosure Rights: Making the Most of Your Mental Health and Substance Use Disorder Benefits – SAMHSA
Summary of MHPAEA – Center for Consumer Information & Insurance Oversight (CCIIO)

Mental Health and Substance Abuse Benefits: 2016 Survey Results

Not sure if your plan complies or not? Here’s some help.

Group Health Plan/Employer Resources from Department of Labor (DOL):
Mental Health and Substance Use Disorder Parity Compliance Assistance Materials Index
Warning Signs: Plan or Policy NQTLs that Require Additional Analysis to Determine MHPAEA Compliance
Mental Health Parity Provisions
Fiscal Year 2016 MHPAEA Enforcement

Related: The Opioid Abuse Epidemic and Your Benefit Plan

MHPAEA requires many health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care.

This requirement applies to:

  • Copays, coinsurance, and out-of-pocket maximums
  • Limitations on services utilization, such as limits on the number of inpatient days or outpatient visits that are covered
  • The use of care management tools
  • Coverage for out-of-network providers
  • Criteria for medical necessity determinations

MHPAEA does not require health plans to offer coverage for mental illnesses or substance use disorders in general, or for any specific mental illness or substance use disorder. It also does not require plans to offer coverage for specific treatments or services for mental and/or substance use disorders. However, coverage that health plans do offer for mental and/or substance use disorders must be provided at parity with coverage for medical or surgical health conditions.

MHPAEA is the law. You need to know what’s in it.

Lois Gleason, CEBS
Lois Gleason, CEBS
Manager, Reference/Research Services at the International Foundation

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