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Coverage Requirements

Can a plan sponsor opt out of offering mental health or substance use disorder coverage entirely (self-funded and/or fully insured)?

The MHP Act applies to group health plans offering mental health or substance use disorder benefits. It does not require that applicable plans offer these benefits. We strongly recommend however, that plan sponsors do not eliminate offering mental health/substance abuse coverage. Additionally, state law will continue to apply and may, for example, mandate certain mental health/substance abuse coverage.

Is electing not to offer mental health benefits a responsible alternative to parity?

It has been well established that behavioral health issues are a primary driver of medical costs. There are, for example, high rates of depression with most chronic conditions. These lead to higher medical costs, poorer clinical outcomes and loss of productivity. By addressing the cost of treatment, the MHP Act helps remove a barrier preventing people from using their benefit to get necessary services. Parity creates opportunities to treat members early before conditions worsen and become more costly.