Parity rules keep mental health benefits on equal footing.
Federal parity law says group health plans that cover mental health and substance use disorder benefits cannot make them harder to use than medical and surgical benefits.
The Basics for Employers.
A plain-English summary. This is general information, not legal advice, and the rules change, so check the current text.
Financial Requirements
Copays, deductibles and limits for mental health benefits cannot be more restrictive than for comparable medical benefits.
Treatment Limits
Visit limits and other treatment limits are held to the same standard.
Comparative Analysis
Plans must be able to show that limits such as prior authorization are applied comparably.
How it plays out.
The Mental Health Parity and Addiction Equity Act says a group health plan that covers mental health or substance use benefits cannot apply limits that are more restrictive than those on medical and surgical benefits. The rule does not require a plan to cover mental health, but it sets the terms when it does.
The rule covers numbers, like copays and visit limits, and also non-numeric limits, like prior authorization and network rules. The non-numeric side is where most disputes arise, and plans are required to be able to show a comparative analysis.
Employers often rely on the carrier or administrator for this, but the plan sponsor remains responsible for the plan’s compliance. Asking for the carrier’s comparative analysis and keeping it on file is a sensible step.
Where This Shows Up in Your Plan.
ERISA, ACA Reporting and Form 5500 Support
How we help with the filings, notices and plan documents.
Employer Benefits Guides: Eligibility, Plan Design, Life Events and Rules
Eligibility, plan design and life-event rules in one place.
What to ask for.
Request the Analysis
Ask the carrier or administrator for its comparative analysis.
Review Limits
Compare visit limits and cost sharing across benefit types.
Check Prior Authorization
Look at how it applies to each type of benefit.
File It
Keep the analysis and the date received.
Mistakes to avoid.
Assuming the Carrier Handles It
The plan sponsor stays responsible.
Only Checking Copays
Non-numeric limits count too.
No Documentation
An undocumented review is hard to show.
Other Rules Employers Work With.
Newborns’ and Mothers’ Health Protection Act
29 U.S.C. 1185
Women’s Health and Cancer Rights Act
29 U.S.C. 1185b
Affordable Care Act
Public Law 111-148
Laws and Rules Referenced
Mental Health Parity (29 U.S.C. 1185a) — The statute or rule text from its official or public source.
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