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51+: Additional Guidance for Mental Health Parity

Aug 09, 2010


This information pertains to Large Group Employers (51+ employees)

 

On July 1, the federal Departments of Labor, Treasury, and Health and Human Services issued additional guidance concerning the Federal Mental Health Parity Act (MHP) regarding outpatient facility and outpatient professional services. This additional guidance has given Anthem the opportunity to add back cost shares (copays) for outpatient office visits, which in turn gives our clients predictability.

Standard plans have been retested with outpatient facility and office visits split out. The outcome from the testing reverses the original guidance allowing copays to be applied to office visits. This is limited to primary care copays for HMO and CareAdvocate Plans (and not specialist copay). There will be no changes to outpatient facility benefits. 

As you may recall, simultaneous to the issuance and notification of this new guidance, on July 1st an eblast was sent to Anthem employers and brokers providing an update on MHP. This additional guidance supersedes the information released in that eblast.

Here is a brief overview of the changes: 

Products

Mental Health/Substance Abuse Benefit

Eff 7/1/2010  -
Mental Health Cost Share

Eff 10/1/2010  -
NEW Mental Health Cost Share

All Large Group Medical

Residential Treatment Center mapped to SNF day limit

Residential Treatment Centers will not be subject to day limits

SAME  - no additional changes

Large Group HMO/POS

Outpatient Facility-based Treatment

Outpatient Facility-based treatment must equal "no copay".  Deductible waived for plans with a deductible.

SAME  - no additional changes

Large Group HMO/POS

Outpatient Physician Visits

No Copay

HMO PCP office visit copay

Large Group PPO/EPO/BC PPO

Outpatient Physician Visits
In-Network

Mirror the outpatient facility-based coinsurance.
Deductible waived if office visit deductible waived.

Office visit copay. 
Deductible waived if office visit deductible waived.
Note: CareAdvocate Plans must mirror the primary physician copay and not the specialist copay.

Large Group Classic PPO 5, Select PPO (except Select PPO 4)/BC PPO

Inpatient Physician Visits,
Out-of-Network

Coinsurance changed to no copay

SAME  - no additional changes

Large Group Classic PPO 5, Select PPO (except Select PPO 4)/BC PPO

Outpatient Facility-based Treatment
Out-of-Network

Remove $350/day limit

SAME  - no additional changes

Large Group Classic PPO 5, Select PPO (except Select PPO 4)/BC PPO

Outpatient Physician Visits,
Out-of-Network

Coinsurance changed to No copay

Coinsurance remains as coinsurance

Anthem appreciates your continued trust and loyalty. If you have any questions, please contact your b&p Group Sales Representative.

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