Parity of Mental Health and Substance Use Benefits with
Other Benefits: Using Your Employer-Sponsored Health Plan
to Cover Services
If you are someone who is trying to figure out how to use your health coverage provided by your employer to pay for your mental health or substance use services – this sheet is for you. Your health plan or health coverage is sometimes called health insurance.
Parity of mental health and substance use benefits
There is now a United States law stating that certain health plans must cover mental health and substance use (MH/SU) services comparably (in a similar way) to medical and surgical care, or what most people refer to as physical health. 1 Many simply refer to the requirement of the law as parity, as we do here.
In this document, we explain MH/SU parity, answer questions about the parity law, and provide ways to learn more. We hope you use this information to get the mental health and substance use services you and your family need paid for (either fully or partially) by your health plan. You may want to talk about this information with your doctor, therapist, your family members, or others who help you with your MH/SU care.
Here you will learn about:
Laws about parity of MH/SU benefits with other physical health benefits
Reasons why some MH/SU benefit claims are denied
How to file an internal or external appeal if your claim is denied
Ways to learn more about parity, your MH/SU benefits, and appeals of denied claims.
Does my health plan offer parity for MH/SU benefits?
Most employer-based health plans, but not all, must offer parity for MH/SU benefits.2 These are health plans that people get from where they work.
Not all health plans are required to provide MH/SU benefits. Parity only applies to health plans that provide MH/SU benefits.
Parity applies to private employer plans with 51 or more workers.
Parity also applies to smaller employers that started offering benefits or made major changes to their health benefits after the Affordable Care Act came into effect in 2010. This includes most small plans.
Parity also applies to most health insurance coverage sold to individuals. This includes coverage sold through the health insurance marketplace.3
Health plans that are only for retirees do not need to comply with MH/SU parity
What does parity mean in terms of MH/SU benefits?
Parity means that financial requirements (such as copayments, deductibles, coinsurance or out-of-pocket maximums) 4 and treatment limitations used by health plans must be comparable for physical and MH/SU services. There are two different sets of parity rules.
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Behavioral Health Rehabilitative Specialist & Addiction Counselor