DOL Issues MHPAEA Publication for Employees

The DOL recently issued a guide to help health plan enrollees understand their mental health and substance use disorder benefits and rights under the Mental Health Parity and Addiction Equity Act (MHPAEA). The goal of MHPAEA is to ensure that people seeking coverage for mental health and substance use disorders can access treatment as easily as people seeking coverage for medical treatments.

MHPAEA applies to individuals who are enrolled in both fully insured and self-insured group health plans that offer both medical/surgical benefits and mental health benefits. MHPAEA does not apply to individuals who are enrolled in retiree-only plans, Medicare plans, church-sponsored plans, and certain small employer plans.

This guide:
 

• Helps group health plan enrollees figure out whether their health plan must provide parity and follow these rules.
• Explains the protections the law provides.
• Highlights "red flags" to look out for.
• Demonstrates how to learn about mental health and substance use disorder benefits.
• Walks through what to do if mental health and substance use disorder benefits have been denied.

The guide includes the below comparison chart that shows comparable classifications between mental health and substance use disorder benefits and medical/surgical benefits. Under MHPAEA, there cannot be different financial requirements or treatment limitations on benefits that are in the same classification. For example, if a health plan charges a $50 copay to see an in-network psychiatrist and a $25 copay for an in-network primary care provider visit, that would likely violate mental health parity, since both providers are in the same classification (outpatient, in-network).

This guide also provides the below examples of health plan designs that may violate mental health parity rules. These red flags serve as a helpful reference for employers when reviewing their plans to ensure impermissible limitations are not set against the mental health benefits.

• The health plan requires preauthorization or concurrent review for all mental health benefits (for example, only approving a few days of benefits at a time before requiring another preauthorization).
• The plan's network of providers of mental health treatment is much less complete than its network of medical providers, making it far harder or impossible for an enrollee to find providers who will give the enrollee-covered treatment at in-network rates.
• The plan requires preauthorization every three months for medications prescribed to treat mental health conditions.
• The plan refuses to cover mental health treatment because an enrollee failed to complete previous treatment or because there is no “likelihood of improvement."
• The health plan requires that an enrollee’s treatment plan must be updated and submitted every six months or it will not be covered.

Takeaways

The DOL, HHS, and IRS (the departments) recently announced proposed MHPAEA rules and have increased their enforcement of MHPAEA requirements. (For information about the proposed rules, please see the article published in the August 3, 2023, edition of Compliance Corner.) Though this guide was intended for health plan enrollees, it is a helpful guide for employers as it provides practical examples of plan benefit designs that fail to meet the MHPAEA requirements. Further, employers should ensure that their mental health benefits are indicated clearly in SPD, SBC, and other employee communication materials that outline plan benefits.

Employers may share this guide with employees to promote employees’ understanding of MHPAEA rules and their rights.

Understanding Your Mental Health and Substance Use Disorder Benefits (dol.gov) »