Insurance

Insurance Commissioner Educates Pennsylvanians on Significance of Mental Health and Substance Use Disorder Law

Harrisburg – Pennsylvania Acting Insurance Commissioner Michael Humphreys today reminded consumers that enforcing the robust protections of the Mental Health Parity and Addiction Equity Act (MHPAEA) remains a top priority for the department. Humphreys encouraged Pennsylvanians to better understand the benefits they are entitled to under state and federal law and how to file complaints if consumers believe they are not receiving the proper coverage, while offering the Insurance Department as a resource for the public.

Under the Affordable Care Act (ACA) and MHPAEA, health insurance plans and insurers must offer mental health and substance use disorder benefits that are no less restrictive than their coverage for medical or surgical care. These benefits include quantitative limitations (copays, deductibles, and limits on inpatient or outpatient visits that are covered) and non-quantitative limitations (pre-authorizations, providers available through a plan’s network, and what a plan deems “medically necessary”).

The MHPAEA law was incorporated into Pennsylvania law in 2010 through Act 14. Currently, Pennsylvania law requires parity for individuals with the following health plans:

  • Individual and small group health plans, as required by the Affordable Care Act;
  • Large group health insurance plans (self-insured and fully-insured plans for more than 50 employees. However, these plans are not required to cover mental health and substance use disorders, but if they offer coverage there must be parity with medical and surgical benefits);
  • Children’s Health Insurance Program (CHIP) and some Medicaid plans.

 In recognition of Mental Health Awareness Month, the Pennsylvania Insurance Department (PID) is highlighting its continued work to ensure that insurers operating within the commonwealth are following state and federal parity laws, allowing those faced with mental health or substance use disorders continued access to needed care.

“The Wolf Administration has made consumer protection and rights a priority, and today, the department is emphasizing your right to receive coverage for mental health treatment under federal and Pennsylvania law,” said Acting Commissioner Humphreys. “Worrying about the cost of treatment should never be a deterrent to receiving the care you need, and that applies no less favorably to treatments for mental health and substance use disorders.”

Plans purchased through Pennie, Pennsylvania’s health insurance marketplace, cover mental health and substance use services as essential health benefits. All plans must cover behavioral health treatment, such as psychotherapy and counseling, mental and behavioral health inpatient services, and substance use disorder treatment.

“For those with comprehensive coverage for themselves and those with families, it is important to understand you have rights and there are laws in place to ensure you and your loved ones receive the care you need and deserve,” said Humphreys. 

The Insurance Department is actively engaged in reviewing Pennsylvania’s insurers’ parity analyses and their compliance with parity laws. The objective of parity can only be fully realized if health plans are implementing it correctly, there is proper oversight, and consumers understand their rights.

The department developed an online guide to private health insurance coverage for mental health and substance use disorder treatment. In addition, the department’s Consumer Services can assist if consumers believe their plan does not meet parity requirements for mental health and substance use disorder coverage.

For more information on MHPAEA or to file a complaint, visit insurance.pa.gov or contact the Insurance Department’s Bureau of Consumer Services at 1-877-881-6388.

MEDIA CONTACT:   Thaisa Jones, Insurance, thajones@pa.gov

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