Pennsylvania Insurance Commissioner Conveys Importance of Mental Health and Substance Use Disorder Coverage


HARRISBURG, Pa., June 24, 2016 /PRNewswire-USNewswire/

Insurance Commissioner Teresa Miller today reiterated to consumers that enforcement of the Mental Health Parity and Addiction Equity Act is a priority for her department and encouraged consumers to understand what benefits they are entitled to under the law and to file complaints with the Insurance Department if they believe they are not getting proper insurance coverage.

"Ensuring that Pennsylvanians have access to the mental health and substance use disorder treatments they need is critical," said Commissioner Miller. "The Pennsylvania Insurance Department takes this law very seriously, and we will us our statutory authority to enforce parity requirements on plans over which we have jurisdiction."

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires health insurance plans to contain the same level of coverage for mental health and substance use disorders as for medical or surgical care. This coverage includes quantitative limitations (copays, deductibles, and limits on inpatient or outpatient visits that are covered) and non-quantitative limitations (pre-authorizations, providers available through a plan's network, and what a plan deems "medically necessary").

The law was incorporated into Pennsylvania law in 2010 through Act 14. Currently, the law requires parity for individuals with the following health plans:

  • Individual and small group health plans, as required by the Affordable Care Act;
  • Large group health insurance plans (self-insured and fully-insured plans for more than 50 employees. However, these plans are not required to cover mental health and substance use disorders, but if they offer coverage there must be parity with medical and surgical benefits);
  • Children's Health Insurance Program (CHIP) and some Medicaid plans.

The Pennsylvania Insurance Department currently reviews all individual and small group plans to ensure plans contain all state and federal policy requirements, including mental health parity. This review will also be extended to large group plans for the 2018 policy year. The department is not required to review large group plans but is choosing to do so in order to take a comprehensive approach to parity enforcement across Pennsylvania.

At Commissioner Miller's direction, the Insurance Department is also in the process of conducting market conduct examinations to ensure that insurance companies are in compliance with state and federal law. These examinations, which will continue over the next 18 months, emphasize mental health and substance use disorder parity as a key point.

"Mental health parity in individual and small and large group plans is a key factor of the Affordable Care Act," said Commissioner Miller. "My department will be vigilant in ensuring that Pennsylvanians are receiving the benefits that they are entitled to under state and federal law."

Since Commissioner Miller took office in January 2015, the Insurance Department has worked to educate consumers on the MHPAEA so they are aware of how the law relates to their health insurance plans. Detailed FAQs on MHPAEA are available on the department's website.

Commissioner Miller also urged consumers to contact the department's Bureau of Consumer Services if they think their plan does not meet parity requirements for mental health and substance use disorder coverage or have questions about the benefits to which they are entitled.

"My department is here to be a resource for consumers and works hard to help all Pennsylvanians understand what benefits they are entitled to have access to through their health insurance plans," said Commissioner Miller. "Bringing issues to our attention may help us identify areas where parity isn't being implemented correctly. Even if a plan isn't under our jurisdiction, we can help consumers contact the state's Department of Human Services or the federal Department of Labor so that issues can be properly addressed."

For more information on the Mental Health Parity and Addiction Equity Act or to file a complaint or ask a question, or call 1-877-881-6388.

MEDIA CONTACT: Ron Ruman, 717-787-3289