Know Your Rights: Parity for Mental Health and Substance Use Disorder Benefits
MHPAEA protects your mental health and substance use disorder benefits. Read more about these protections here
MHPAEA: A law that protects your mental health & substance use disorder benefits.
The Mental Health Parity and Addiction Equity Act (MHPAEA) provides federal protections for certain types of health plans. This parity requires health “insurance” plans to cover mental health and substance use disorders in a similar way to medical and surgical benefits.
It also means that financial requirements – like copayments/copays and deductibles – need to be similar in cost. In addition to those protections, MHPAEA makes sure yearly visit limits, needs for prior authorization and proof of medical necessity are comparable.
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Protection from additional restrictions and higher costs.
Learn more about our investigations and enforcements.
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Guards against insufficient benefits.
Group health plans and insurers need to include out-of-network providers and inpatient benefits to treat mental health or substance use disorders – if similar benefits are available for medical or surgical care.
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Prohibits higher financial requirements.
Most health plans can’t charge higher copays to see mental health providers. These costs need to be similar to what’s being charged when visiting a medical or surgical provider.
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Gives you a right to information.
The Patient Protection and Affordable Care Act (ACA) adds many protections related to job-based group health plans for you and your family.
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Eliminates restrictive non-quantitative treatment limitations (NQTLs).
A majority of health plans can’t require preauthorizations for all mental health and substance use disorder treatments. Written treatment plans should not be requested for mental health services if there aren’t similar requirements for medical or surgical care.
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Prevents lower annual dollar limits on benefits.
In most cases, group health plans and insurers can’t lower annual dollar limits for mental health or substance use disorder services. These benefits need to be similar to medical and surgical care.
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Blocks restrictive quantitative treatment limitations (QTLs).
Visit limits on mental health benefits can’t be more restrictive than those applied to medical or surgical visits for a majority of health plans.
Additional Resources
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Using Your Job-Based Health Plan to Cover Services
Are you covered by a health plan or health insurance? Learn why health plans and insurance companies deny some mental health or substance use disorder claims, and learn how to file an appeal.
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Understanding Parity: A Guide to Resources for Families and Caregivers
Learn what family members and caregivers of those with mental health conditions or substance use disorders need to know about parity under the law.
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Top 10 Ways to Make Your Health Benefits Work for You
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Do you want to get more out of your healthcare benefits? Explore these top tips for using and understanding your plan.
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Mental Health and Substance Use Disorder Insurance Help
Find out what your health plan is required to provide, how to file a complaint, and where to find treatment services.
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Disclosure Guide: Making the Most of Your Mental Health and Substance Use Disorder Benefits
This publication provides a general explanation of the various federal disclosure laws affecting private-sector, job-based group health plans.
