Federal Mental Health Parity for Employer Plans
What the Mental Health Parity and Addiction Equity Act requires of group health plans, what the Department of Labor said in September 2026, and where the Michigan parity law fits.
What Federal Parity Requires
The Mental Health Parity and Addiction Equity Act says group health plans that cover mental health and substance use disorder benefits cannot make them more restrictive than medical and surgical benefits.
Financial Requirements
Copays, coinsurance and deductibles on mental health and substance use benefits cannot be more restrictive than those that apply to substantially all medical and surgical benefits. Employers can ask the carrier to show how these cost-sharing levels were compared with medical benefits. Counsel can help interpret the test for your plan, since the comparison is made within benefit classifications rather than across the whole plan.
Nonquantitative Treatment Limits
Rules that limit scope or duration of treatment without a number, such as prior authorization, medical necessity review and network standards, are called nonquantitative treatment limits. They must be comparable and applied no more stringently. Employers should ask how these rules are applied to your plan and who reviews them. Employees rarely see these limits directly, but they can feel them as delays, denials or hard-to-find providers.
Comparative Analysis
The Consolidated Appropriations Act of 2021 requires plans to document a comparative analysis of their nonquantitative treatment limits and provide it on request. Employers should know whether a written analysis exists for their plan, who prepared it and how to request it. Counsel can help review the document and decide what follow-up questions to raise with the carrier or administrator.
Who Is Covered
The law applies to group health plans that offer mental health or substance use disorder benefits, whether fully insured or self-funded. Your carrier or administrator usually prepares the analysis. Confirm who owns it. Even if the carrier or administrator does the work, the plan sponsor remains responsible for knowing the status. Keep a record of who prepared the analysis and when, and ask for updates when plan terms change.
Michigan Overlay
Michigan has its own parity statute for insured plans. See our guide to Michigan mental health parity. Employers with insured plans should keep both layers in mind, because the state law may add requirements beyond the federal ones. Ask the carrier how its plan documents address both, and have counsel confirm how they apply to your group.
Why Employers Care
The plan sponsor carries fiduciary responsibility. A carrier that cannot produce its comparative analysis is a risk to the employer. Employers should therefore ask for the analysis, read it with counsel and keep it on file. A sponsor that has asked the right questions and documented the answers is in a better position than one that never inquired.
The Department of Labor Enforcement Bulletin
We read this from a law firm summary of the bulletin. Confirm against Field Assistance Bulletin 2026-03 on dol.gov before acting on it.
What Was Issued
The Department of Labor lists Field Assistance Bulletin 2026-03, titled as guiding principles for its enforcement of the nonquantitative treatment limitation requirements. Federal guidance in this area has been moving, so employers should check with counsel on how the bulletin affects their plan and whether the carrier or administrator has updated its approach.
The 2024 Final Rule
Under a May 15, 2025 statement, the Departments will not enforce the parts of the 2024 final rule that are new compared with the 2013 rule, which includes the meaningful benefits standard. Statutory requirements as amended in 2021 still apply. Ask counsel how this affects your plan and what documentation to keep. A paused rule does not remove all expectations.
What Still Applies
The statutory comparative analysis obligations from the Consolidated Appropriations Act of 2021 remain in effect and enforceable. Employers should therefore keep asking carriers and administrators for the required analysis and confirm that it is current. Counsel can advise on how long to retain it and what to do if it is missing or incomplete.
Priority One: Treatment Exclusions
Blanket exclusions that apply only to mental health or substance use benefits when similar medical or surgical treatments are covered. Employers should ask whether their plan contains any exclusion of this kind, such as a blanket denial of a type of treatment that would be covered for a medical condition. Counsel can help evaluate any exclusion that the carrier identifies.
Priority Two: Medical Necessity and Review
Prior authorization, concurrent review and retrospective review. Plans must provide proprietary clinical guidelines on request. Employers can ask the carrier how often these reviews are used for behavioral health compared with medical care and whether the clinical guidelines are available on request. The pattern of reviews often reveals more than the written policy does.
Priority Three: Network Adequacy
Network admission standards and provider reimbursement methods. Plans should avoid leaving participants with out-of-network costs when in-network options are lacking. Employers can ask for the number of behavioral health providers actually accepting new patients, wait times for appointments and how reimbursement compares. Where employees cannot find in-network care, they may pay more out of pocket and complain to HR.
How Long the Relief Lasts
Under the May 15, 2025 statement, relief lasts until a final decision in the pending industry lawsuit, plus an additional 18 months. Because the legal situation is unsettled and the agencies have been reconsidering the rule, employers should not assume the position will last, and should ask counsel to track developments. Keep documentation in good order either way.
A Practical Checklist for Plan Sponsors
Ask for the Analysis
Request the nonquantitative treatment limit comparative analysis from your carrier or administrator and keep a copy. A written request creates a record of the ask, and the response, or lack of one, tells you something about the vendor. Share the analysis with counsel and revisit it when benefits, networks or carrier processes change.
Check Blanket Exclusions
Review the plan for exclusions that apply only to mental health or substance use treatment. Read the benefit summary and certificate with this in mind, and ask the carrier to list any such exclusions in writing. If one turns up, bring it to counsel and ask the carrier how it justifies the difference.
Check Authorization Rules
Compare prior authorization and review requirements for mental health benefits against medical and surgical benefits. Create a simple side-by-side list of which services need approval in each category and how long the reviews take. Differences are not automatically a problem, but they are the right place to ask the carrier for an explanation.
Check the Network
Ask how many in-network mental health providers accept new patients near your employees. Test the directory by looking for real appointments, not just names on a list, and ask employees to report problems. Share what you learn with the carrier at renewal, and ask what steps it takes to widen access.
Keep Records
Document who is responsible for parity compliance and when it was last reviewed. A short file with the names of the people involved, the dates of each review and any open questions makes the next review easier. It also helps if leadership or counsel later asks how the plan has handled the requirement.
Questions Employers Ask
Does Parity Apply to Self-Funded Plans?
Yes. The federal law applies to group health plans whether fully insured or self-funded.
Is the Comparative Analysis Still Required?
Yes. The statutory requirement from the Consolidated Appropriations Act of 2021 remains enforceable per the September 2026 bulletin.
What Did the 2024 Rule Add?
New standards such as the meaningful benefits standard. Under a May 15, 2025 statement, the Departments will not enforce those new parts until a final decision in the related lawsuit, plus 18 months. Statutory requirements still apply, so confirm the current status with counsel.
Who Prepares the Analysis?
Usually the carrier or administrator, but the plan sponsor remains responsible. Ask for it.
How Does This Relate to the Michigan Law?
Michigan has its own parity law for insured plans. See our Michigan guide.
Where Is the Bulletin?
Field Assistance Bulletin 2026-03 is published by the Department of Labor. Read it directly.
Does Our Broker Prepare It?
We help you collect it and review it with the carrier. The analysis itself is prepared by the carrier or administrator.
Is This Legal Advice?
No. This is general information from benefits advisors. Consult your attorney.
Related Guides
Related reading: Michigan Mental Health Parity Law · Michigan Benefits Compliance Hub · Michigan Compliance Calendar · ADA and GINA Rules for Employer Wellness Programs
Where the Rules Come From.
The laws and rules named on this page link to the statute or regulation they come from. This is general information, not legal or tax advice, and rules change, so check the current text.
Mental Health Parity (29 U.S.C. 1185a)
Parity rules for mental health and substance use disorder benefits in group health plans.
Americans with Disabilities Act (42 U.S.C. Chapter 126)
Prohibits disability discrimination in employment and other areas.
Genetic Information Nondiscrimination Act (42 U.S.C. Chapter 21F)
Limits use of genetic information by group health plans and employers.
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