How the act works

Here, in a nutshell, is what the Mental Health Parity and Addiction Equity Act does for mental health insurance.

Group health plans that include mental health benefits along with medical/surgical benefits:

•Must provide the same deductibles and co-pays.

•Cannot have treatment limitations that are more restrictive for mental health.

•Cannot have different physical-health and mental-health divisions for other cost-sharing requirements, such as co-insurance (the percentage you have to pay for services after you’ve paid your deductible) and annual out-of-pocket maximums.

•Must provide out-of-network benefits for mental health and substance abuse treatments if these are offered for medical/surgical treatments.

•Must provide reasons if they deny benefits because they deem a service medically unnecessary.

•Must offer lifetime annual dollar benefits for mental health and substance abuse that are equal to those for medical/surgical treatments.

—Tammy Worth