Employers must ensure physical, mental health benefits are equivalent

In January, the Departments of Labor, Health and Human Services, and the Treasury issued their 2022 report to Congress on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

The report includes information suggesting that health plans and health insurance issuers are failing to deliver parity (i.e., comparable benefits) for mental health and substance-use disorder benefits to those they cover.

The report also highlights the departments’ recent emphasis on greater MHPAEA enforcement in addition to guidance to correct those failures. It also makes recommendations to strengthen MHPAEA’s consumer protections and enhance the departments’ enforcement abilities.

In general, MHPAEA mandates that the financial requirements and treatment limitations for mental health and substance-use disorder benefits cannot be more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical and surgical benefits.

This could include, for example, copayments and prior authorization requirements imposed by a group health plan or health insurance issuer.

The report cites specific examples of health plans and health insurance issuers failing to ensure parity.

For example, a health insurance issuer covered nutritional counseling for medical conditions like diabetes, but not for mental health conditions such as anorexia nervosa, bulimia nervosa, and binge-eating disorder.

To aid in compliance, employers should work with their insurance carriers or a third-party administrator to analyze coverage data to ensure parity.