February 22nd, 2010

Reports the Times Herald:

Those who provide and need mental health services now have some parity in the new year, yet loopholes remain in the coverage.

The Mental Health and Addictions Parity Act of 2008 went into effect Jan. 1, sponsored by the late Sen. Paul Wellstone, of Minnesota and former New Mexico Sen. Pete Domenici.

It was signed into law by former President George W. Bush, as part of the Troubled Asset Relief Program.

In essence, the act states that if a U.S. health insurance company provides coverage for mental health and substance abuse, then the coverage must be equal for psychological disorders, alcoholism and drug addiction. This also goes for those covered by self-insured plans.

“What it says is that if you are an employer who has more than 50 employees and you have a health insurance plan with a mental health and substance abuse benefit to it, you are required to provide mental health coverage at parity with other medical conditions,” said Dr. Frank Sergi, of IntroSpect of BuxMont in Colmar, a private mental health practice. “That means deductibles are the same, co-payments are the same and out-of-pockets are the same. Traditionally, those are higher for mental health.”

…

“Now parity says, if you can go out of the network for medical reasons and have 80 percent coverage, then you will be able to see someone for mental health care and have the same 80 percent coverage,” Sergi said. “It gives them more choices. The insurance company must provide parity and they can no longer discriminate.”

However, loopholes exist in the act.

First, realize it is about parity and not about having coverage.

“Employers decide if they want this or don’t want it; they don’t have to provide mental health coverage,” Sergi said. “If an employer opts in with health care benefits that include mental health, then they must provide parity.”

It’s a heavier burden on a small business versus a big business to provide insurance. And if they have fewer than 50 employees, they are exempt from the parity law.

Find out more.