Insurance Parity

What is insurance Parity?

Americans often have more difficulty getting treatment for mental health and substance use disorders than they do accessing other treatments, even those with health insurance.  Insurance plans oftentimes charge more or place restrictions on mental health and substance use disorders. Federal and state parity laws are designed to change this and make health insurance plans treat individuals with mental health and substance use conditions fairly, and ensure that they treat mental health and substance use disorders equally with physical health.

Did you know there is already a Federal Parity Law?

The Mental Health Parity and Addiction Equity Act (MHPAEA, also known as the Federal Parity Law) was passed in 2008 and requires health insurance plans to cover mental health and substance use disorder (MHSUD) benefits and physical health benefits equally. Unfortunately, enforcement of federal parity can be very difficult and many states are not enforcing the Federal Parity Law. This requires states to enact their own legislation. The Federal Parity Law states: 

• Health insurance plans CANNOT have higher co-payments and other out-of-pocket expenses for MHSUD benefits than they do for other medical benefits.
• Health insurance plans CANNOT put higher limitations on the number of visits or days of coverage for MHSUD healthcare than they do for other medical care.
• Health insurance plans CANNOT use more restrictive managed care practices for MHSUD benefits than they use for other medical benefits.

The Federal Parity Law recommends but does not require that health insurance plans refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) when reviewing medical necessity criteria, unfortunately, many insurance companies are creating their own medical necessity criteria as seen in Wit v. UBH. Mandating that insurance companies use current DSM and ICD standards will prevent insurance companies from creating their own medical necessity criteria and help patients receive the appropriate care at the appropriate time. 

The Federal Parity Law does not require that all health insurance plans cover MHSUD, but if they do, the coverage must be comparable to what’s in place for other medical care.

State Parity Laws can also provide additional rights beyond the Federal Parity Law. Learn more about state parity laws and legislative efforts to improve those laws here and here.

*Parity plans are not required for every health insurance plan and not every plan is subject to state or federal parity laws.

AZ Coalition for Insurance Parity

We did it! The AZ Coalition for Insurance Parity was enacted to ensure all residents of Arizona are able to access appropriate physical, mental health, and substance use disorder treatment through their insurance coverage.

The state of AZ is 17th in the nation for suicide losses and not enough was being done. Suicide is the second leading cause of death for people aged 15-34 in AZ. Unfortunately, many were not able to access care when they desperately need it. That is why we are worked diligently to enact state legislation that would require insurance companies to treat mental health equally with physical health. We did it! To learn more about Jake’s Law click here

If you or a loved one are being denied care please visit our page on what to do if a loved one is denied care

How you can help:

1. Get educated about parity.
2. Talk about parity. Many don’t know what parity is, or they don’t know the issues involved. Educating the public will help us strengthen parity laws across the country.
3. Write your US Senators, Kyrsten Sinema, and Martha McSally and ask them to support stronger Federal Parity Laws. 
4. File an insurance appeal if you are denied care or log a complaint. Click here to visit The Kennedy Forum and log a complaint or get help filing an appeal.
5. Volunteer your time. Non-profits like JEM are always looking for help. We need graphic artists, video creators and producers, marketing, and more…
6. Donate money; Lobbying for change is expensive and organizations need your help.