The Mental Health Parity Act: What it Means to You

• Plans can't impose more restrictive annual or lifetime limits on mental health or substance abuse benefits than they do on medical or surgical benefits. This means your health plan can't cap your mental health benefits per year at $5,000 if your medical benefits are capped at $25,000.
• Plans can't require more restrictive financial requirements, such as co-payments, deductibles, etc., on treatment for mental health or substance abuse treatment than for medical or surgical benefits. This means that your plan can't require you to pay $50 for a co-payment to see your psychiatrist when your co-payment for a medical specialist, such as a neurologist, is only $30.
• Plans can't impose more restrictive limits on frequency or total use of mental health or substance abuse benefits than medical or surgical benefits. This means, for example, your health plan can't limit you to only three visits to a psychologist a year but allow you five visits to your dermatologist.
• Plans must provide similar in-network and out-of-network benefits for all coverages. This means if your medical benefits provide out-of-network coverage for medical or surgical benefits, they must also provide them for mental health and substance abuse benefits.
• Plans must clarify and make available the criteria used for determining medical necessity of mental health and substance abuse benefits.