Mental Health and Substance Use Disorder Parity: Know Your Benefits

What is Parity?

Health benefits are physical health, mental health and substance use disorder services paid for by health plans. Services for mental health and substance use disorder services must be “in parity” with services for physical health. That is, health plans must apply similar rules to mental health and substance use disorder benefits as they do to physical health benefits.

How Parity Applies to You

Under your health plan, benefits for mental health and substance abuse services can’t be more restrictive than benefits applied to physical health. The benefits covered by parity protections include:

• Financial - deductibles, copayments, coinsurance, and out of pocket limits.
• Treatment - limits to the number of days or visits covered.
• Care management - requirements to get authorization of treatment before receiving care.

Exercise Your Rights

Steps to take if you believe your health plan is in violation of parity:

• Contact your health plan. Health plans must provide information about physical/mental health benefits it offers, including criteria it uses to decide if a treatment is covered. If your plan denies payment, it must give you the reason for the denial in writing.
• File an appeal. If your health plan denies a claim, you have the right to appeal the denied claim.
• Contact your health plan’s state regulator at any time. The three state agencies listed below oversee health plans in Minnesota. They are available to assist you with questions or concerns you have about parity or your health plan.
• For public program enrollees, contact the Minnesota Department of Human Services Ombudsman for Public Managed Health Care Programs at 651-431-2660.
• For individual or small group insurance policy enrollees contact the Minnesota Department of Commerce at 651-539-1600 or 800-657-3602.
• For individual or small group HMO policy enrollees contact the Minnesota Department of Health at 651-201-5100 or 1-800-657-3916.