Understanding ERISA’s Mental Health Parity Act

On Behalf of | Oct 18, 2019 | Uncategorized |

Mental health struggles have become an epidemic in the U.S. In Texas specifically, one out of five adults will experience a mental health issue this year. Sadly, more than 20% of children ages 9-17 are already diagnosed with mental health problems.

Being that it’s so common, nearly everyone is affected by the struggle with mental health in some way—whether the affected individual is you or someone you love. The government has put in regulations to ensure that private sector health plans cover the widespread problem of mental illness in the form of The Mental Health Parity Act, which is one of the most significant amendments to the Employment Retirement Income Security Act (ERISA) in recent years.

What does mental health parity mean?

Mental health and substance abuse parity means that, if your employer offers benefits for these conditions, their coverage must be comparable to that provided for medical and surgical care. This avoids penalizing individuals who seek this kind of care, which can be just as debilitating as a physical issue affecting another body system.

What needs to be equal

  • Aggregate lifetime and annual dollar limits. This simply means that the total amount spent on benefits has a cap every year.
  • Bills. Financial requirements for copayments and deductibles must be similar.
  • Number of visits allowed. The maximum visits and any treatment limitations quantified by a number must be equivalent.
  • Non-quantitative treatment limitations. This means the standard for prior authorizations and other non-numerical treatment restrictions need to be comparable.
  • Free information. The information on one’s options must be readily available for the individual in both the case of mental health and substance use benefits and medical and surgical benefits.

ERISA and the Mental Health Parity Act work together to ensure that Americans receive the benefits they are entitled to by law. You should never be denied treatment based on the nature of your illness, whether mental or physical. If you have been denied benefits, seek out ERISA representation in the form of an experienced lawyer who can help you through this time and get you the help and compensation you need to treat your—or a loved one’s—condition.


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