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Broker News | Vol. 9, No. 6 | May 16, 2014
Broker News | Vol. 9, No. 6 | May 16, 2014

Federal Mental Health Parity Final Regulations: What You Need to Know by July 1

On November 8, 2013, the Departments of Treasury, Health and Human Services, and Labor published final regulations implementing the Mental Health Parity and Addiction Equity Act of 2008.

The Final Regulations apply to group health plans and health insurance issuers for plan years beginning on or after July 1, 2014. The Final Regulations also apply to all individual market insurance, including grandfathered individual market coverage, for policy years beginning on or after July 1, 2014

This mandate applies to:

  • Large group policies, both insured and self-funded, and both grandfathered and non-grandfathered. Changes will take effect on the group’s renewal beginning on 7/1/2014 through 6/1/2015
  • All small group policies are effective on 7/1/2014
  • All Individual policies are effective on 7/1/2014

This mandate does not impact the following products:

  • Self-funded federal governmental plans that opt out of the requirements of the parity law
  • Retiree only plans (plans with fewer than two employees who are current employees)
  • Employee assistance programs that do not provide significant benefits in the nature of medical care and other accepted benefits
  • Medicare supplement policies and Individual Medicare Advantage Plans

What large group benefits are adding or changing as a result of this mandate?

Federal Mental Health Final Regulations will add coverage for:

  • Inpatient mental health and inpatient substance use residential treatment, substance use partial hospitalization, and professional office substance use treatment
  • Inpatient mental health including partial hospitalization will change to outpatient mental health including partial hospitalization

What small group and individual benefits are adding or changing as a result of this mandate?

Small group and individual plans will add coverage for:

  • Inpatient mental health and inpatient substance use residential treatment, substance use partial hospitalization
  • Outpatient mental health including partial hospitalization
    Note: professional office substance use treatment will not be changing for small groups

What do employers need to know and what do they need to do?

  • Fully-insured employer groups will not need to take any action. The Health Plan will amend the contracts to bring the group into compliance with the Federal Mental Health Final Regulations mandate. The benefits will change for members and no action is required.
  • Self‐funded employer groups will need to make changes to their benefit plans to bring their plan offering into compliance with the Federal Mental Health Final Regulations mandate and communicate the changes to their members.

What do individuals need to know and what do they need to do:

Excellus BlueCross BlueShield will amend the contracts to bring the individual plan into compliance with the new mandate. No action is required.

If you have additional questions, please contact your Account Consultant.

 

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