Understanding mental health parity, insurance coverage
Often, when we discuss health insurance, we focus mainly on physical health benefits for operations, hospital visits or medication and don’t mention another important component of well-being: mental health. More than one in five U.S. adults live with a mental illness, according to the Centers for Disease Control and Prevention. Around the same percentage of Oklahomans (almost 790,000 people) experience a mental illness every year. This is a topic I hope enters the conversation more, and I want Oklahomans to understand mental health parity and insurance coverage.
What is parity?
First, it’s crucial to understand what parity is. In this case, mental health parity means mental health coverage under an insurance plan is equal to physical health coverage. Mental health hasn’t always been treated the same as physical health coverage, with this issue addressed by multiple laws over the decades. In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health ParityandAddictionEquity Act of 2008 (MHPAEA), which generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. In Oklahoma, we passed SB1718 in 2020, which requires carriers in the state to offer mental health and substance use disorder coverage in parity.
Is my plan included under mental health parity?
All fully insured health plans sold to individuals, small employer groups and large employer groups must include benefits for mentalhealthandsubstance use disorder services. Self-funded health plans (commonly provided by large employers) aren’t required to cover these services. If they do include this coverage, it must be provided in parity with benefits for physical illness.
In general, rules apply to: parity
Private-sector employment-sponsored group health plans with 51 or more workers
Private plans of smaller employers that started offering health insurance benefits or made major changes to their health insurance plans after March 23, 2010
Plans sponsored by non-federal governmental employers with 51 or more workers (although self-insured non-federal governmental plans can opt out if they follow certain procedures)
Most health insurance coverage sold to individuals, including coverage sold through the Health Insurance Marketplace
Most, but not all, Medicaid managed care programs and all Children’s Health Insurance Program (CHIP) programs
However, parity does not apply to Medicare feefor-service or Medicare Advantage plans.
If my health insurance plan doesn’t treat mental health and physical health equally?
Review your health insurance plan and look closely at your benefits. If you determine your insurer does not meet parity but does meet the above criteria, contact us at the Oklahoma Insurance Department at 800-5220071 or visit oid.ok.gov.