Parsing the Parity Act

What the Mental Health Parity Act means for you

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) The Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act holds many implications for insurers. But what does it mean for you?

The act, otherwise known as the Mental Health Parity Act, managed to pass amid contentious political debate. Basically the law stipulates that insurance providers must cover mental health and addiction treatment and services to the same extent they provide for medical and surgical needs. Sounds like a great deal, right?

Unfortunately, citing cost reasons, some providers, such as the Screen Actors Guild (SAG), have dropped mental health and addiction provisions entirely to circumvent the law.

If your carrier still provides for non-surgical and medical services, however, the news looks good. Here's a brief rundown of some improvements the Parity Act offers to the insured (for now):

Carriers will no longer be able to apply "separate but equal" deductibles to medical and mental health benefits, allowing for a single deductible.

Providers must define the mental health services covered in accordance with "generally recognized independent standards of current medical practice." These standards include those set forth by the Diagnostic and Statistical Manual of Mental Disorders, the International Classification of Diseases and state guidelines.

Insurance companies will no longer be allowed to have employee assistance program (EAP) gatekeepers, whose stringent regulations have prevented many people from receiving mental health benefits in the past.

A new, streamlined classification of benefits are grouped as follows: inpatient, in-network; inpatient, out-of-network; outpatient, in-network; outpatient, out-of-network; emergency care; and prescription drugs.

Insurers cannot set up separate plans or benefit packages to avoid complying with Parity Act requirements.

Financial requirements for drugs prescribed for mental health conditions must be comparable with other prescription drugs in the same formulary tier in which the prescription drug is classified. This will keep insurers from imposing unfair financial requirements for mental health drugs, such as antidepressants.

...These are just a few of the new Parity Act stipulations that stand to benefit you as an insured -- provided your employer still offers mental health coverage.

Reviewed by: 
Review Date: 
December 31, 2010
Last Updated:
December 31, 2010