Bailout #1 Goes Mental

For years, mental health advocates have worked diligently to level the insurance payout field. For years, those seeking mental health services have had to pay higher copay's, or have no coverage at all, be denied services, or have their treatment services cut short. However, this will be a thing of the past thanks to Bailout #1 back in October of 2008. This wonderful addendum was attached like a barnacle to the side of the bailout.

I have taken this from a post on the Pituitary Network Association webpage.

The Parity Requirement. The bill amends the Mental Health Parity Act of 1996 to require that a group health plan of 50 or more employees (or coverage offered in connection with such a plan)¬that provides both medical and surgical benefits and mental health or substance use benefits ¬to ensure that financial requirements and treatment limitations applicable to mental health/substance use disorder benefits are no more restrictive than those requirements and limitations placed on medical/surgical benefits.

• Equity coverage will apply to all financial requirements, including deductibles, copayments, coinsurance, and out-of-pocket expenses, and to all treatment limitations, including frequency of treatment, number of visits, days of coverage, or other similar limits.

• Mental health and substance use disorder benefits are defined broadly to mean benefits with respect to services for mental health conditions and substance use disorders, as defined under the terms of the plan and in accordance with applicable Federal and State law.

• A plan may not apply separate cost sharing requirements or treatment limitations to mental health and substance use disorder benefits.

• If a plan offers two or more benefit packages, the requirements of this Act will be applied separately to each package.

• As under the current Federal parity law, mental health or substance use benefit coverage is not mandated. However, if a plan offers such coverage, it must be provided at parity in accordance with this Act.
Out-Of-Network Benefits. A group health plan (or coverage) that provides out-of-network coverage for medical/surgical benefits must also provide out-of-network coverage, at parity, for mental health/substance use disorder benefits.
Benefits Management and Transparency. As under the 1996 Mental Health Parity Act, a group health plan (or coverage) may manage the benefits under the terms and conditions of the plan. A plan will make mental health/substance use disorder medical necessity criteria available to current or potential participants, beneficiaries or providers upon request. A plan must also make reasons for payment denials available to participants or beneficiaries on request or as otherwise required.

This is wonderful for person's working in the mental health field (as we are not paid enough just like teachers, policeman, etc.). This will also be great for person's seeking mental health services.

Thank you Bailout #1 for recognizing the importance of mentally healthy individuals and families! :)