1. Current regulations went into effect in January of 2010.
The Wellstone and Domenici Mental Health Parity and Addiction Equity Act was passed in 2008, but Interim Final Regulations were released in 2010. All insurance plans that are not specifically exempted from the law must now be in compliance.
2. The law applies to ALL large employers, including self-funded.
It also applies to state government plans and federal employee plans. It does not apply to small employers of 50 employees or less. Medicare and US Department of Defense and TriCare plans are also NOT covered under this law. Learn More
3. Specific regulations for Medicaid have not been created, but Medicaid must be compliant with current regulations.
The Centers for Medicare Medicaid Services are currently working on Medicaid specific regulations, which should be released in 2011. Until that time any managed care organization that offers both medical and mental health or addiction benefits must adhere to current regulations. Learn More
4. The law DOES NOT force an insurer to offer mental health or addiction benefits.
This law does not require plans to offer mental health or addiction benefits, but all covered plans that offer ANY mental health or addiction benefits must offer those benefits on-par with medical surgical benefits. Learn More
5. If your plan has out-of- network medical benefits and ANY mental health or addiction benefits, they must also offer out-of-network mental health and addiction benefits.
The regulations created 6 classifications of benefits that are used to compare the levels of benefits. These classifications cover both in-network and out-of-network services. Learn More
6. There is a penalty for non-compliance with the law. Internal Revenue Service is empowered to assess tax penalty to insurers who are not compliant.
Three federal agencies have policing power over health insurance plans: Department of Health and Human Services, Department of Labor, and the Internal Revenue Service. Complaints by consumers and providers are investigated and the IRS can levy tax penalties each day that an insurer is not in compliance.
7. The regulations state that your financial requirements and treatment limitations can be no more restrictive for mental health or addictions than for your other health benefits.
This means you cannot be forced to pay a higher co-pay or have a limit on your number of visits that is less than for your other health visits. It also means that treatment limitations such as requiring prior authorization for visits cannot be more restrictive for mental health or addiction treatment. Learn More
8. Your insurer must supply you with written reason for denial of treatment and explanation of how they determined whether or not the treatment was medically necessary.
This information must be supplied upon request and free of charge. Learn More
9. You may file a complaint under this law with the Maryland Insurance Administration and the US Department of Labor.
The Maryland Insurance Administration will handle complaints for fully insured plans. The US Department of Labor will handle complaints for government plans, self-funded plans, and Medicaid. Learn More
10. People are waiting to help you file appeals and complaints to make sure you get the treatment you deserve.
The law is only as effective as we make it. We have the right to appeal denials and lodge complaints, but if we don’t use that right it is meaningless. If you feel your insurer may be in violation, contact Adrienne Ellis, Director, Maryland Parity Project, at firstname.lastname@example.org or 410-235-1178, ext. 206. Learn More