A Brief Guide to the Mental Health Parity Law

In 1999 mental health advocates passed a full mental health and substance abuse parity law in Connecticut. NASW, CT Chapter was amongst the leading organizations in lobbying for this statute. The law, Public Act 99-284, became effective on January 1, 2000 and the key provisions are as follows.

TYPES OF POLICIES COVERED: Both individual and group health insurance policies delivered, issued for delivery, renewed, amended or continued in Connecticut.

BENEFITS COVERED: Policies shall provide benefits for the diagnosis and treatment of mental or nervous conditions. “Mental or nervous conditions” means mental disorders, as defined in the most recent edition of the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders” (DSM). Substance abuse is covered in this law as it is identified within the DSM.

CONDITIONS NOT COVERED: “Mental or nervous conditions” does not include mental retardation, learning disorders, motor skills disorder, communication disorders, caffeine-related disorders, relational problems, and additional conditions that may be a focus of clinical attention, that are not otherwise defined as mental disorders in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.

PARITY OF TERMS AND CONDITIONS OF COVERAGE: Health insurance policies that come under this law cannot establish any terms, conditions or benefits that place a greater financial burden on an insured for access to diagnosis or treatment of mental or nervous conditions than for diagnosis or treatment of medical, surgical or other physical health conditions. This includes prohibiting different co-pays, deductibles, and lifetime caps on coverage for mental health and substance abuse coverage than is required for physical health care coverage.

EXEMPTIONS: There are two categories of policies that are exempt, these being:

1.)   Self-insured policies that are exempt from state insurance requirements.

2.)   Policies written out-of-state when less than 50% of those persons covered by the policy are in Connecticut.

It is important to note that policies that are in the above categories may choose to provide Parity even though they are not required to do so.