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Standard Coverage

What will Aetna's standard coverage look like?

Our best understanding of the law at this time without the regulations is that:

• If mental health and substance abuse benefits are offered, the law prohibits imposing more restrictive financial requirements (deductibles, co-payments, co-insurance and out-of-pocket expenses) or treatment limitations (frequency of treatment, number of days, days of coverage) on mental health/substance use disorder benefits than those applied to medical or surgical benefits.



• Plans may not establish separate cost sharing requirements applicable only to mental health benefits.



• If separate benefits plans exist, the parity requirements must be applied to each benefit plan. Limits can exist but must be the same (or better) as for medical benefits.



• Out of network coverage must be offered for mental health/substance abuse if offered for medical



• Parity must be established with respect to pre-certification penalties

Our standard coverage will be in compliance with each of these key components and all requirements of the new law.