What does MHPAEA require regarding mental health and substance use disorder benefits?

What does MHPAEA require regarding mental health and substance use disorder benefits?

• A. They must be excluded from coverage
• B. They can have separate, stricter limits
• C. They must be funded by separate accounts
• D. Parity with medical/surgical benefits in treatment limits and financial requirements

Answer: (D)

MHPAEA requires parity between mental health and substance use disorder benefits and medical/surgical benefits in how treatment limits and financial requirements are applied. In other words, if medical/surgical benefits have certain dollar limits or cost-sharing, the same limits and cost-sharing must apply to MH/SUD benefits. Plans cannot impose stricter annual or lifetime limits, higher deductibles, copays, or coinsurance for MH/SUD care than for medical/surgical care. This ensures mental health and substance use treatment aren’t treated more restrictively. Excluding coverage, allowing separate stricter limits, or needing separate funding aren’t requirements of the law.

MHPAEA requires parity between mental health and substance use disorder benefits and medical/surgical benefits in how treatment limits and financial requirements are applied. In other words, if medical/surgical benefits have certain dollar limits or cost-sharing, the same limits and cost-sharing must apply to MH/SUD benefits. Plans cannot impose stricter annual or lifetime limits, higher deductibles, copays, or coinsurance for MH/SUD care than for medical/surgical care. This ensures mental health and substance use treatment aren’t treated more restrictively. Excluding coverage, allowing separate stricter limits, or needing separate funding aren’t requirements of the law.