51-99 & 51-250 Federal Mental Health Parity Benefit Changes - July 2010
Summary of changes that are effective upon renewal for all Pooled (P) and Non-Pooled (NP) groups (51 or more employees) and 51-99 EmployeeElect groups on or after July 1, 2010. These changes are also effective for all new Pooled and Non-Pooled groups, and 51-99 EmployeeElect groups effective July 1, 2010, and after.
Note: there is a special effective date for collective bargaining union groups. The MHP requirements do not apply to these groups until the later of July 1, 2010, or the date on which the last collective bargaining agreement relating to the plan terminates.
Description of Federal Mental Health Changes for July 2010
The Mental Health Parity and Addiction Equity Act (MHPAEA) is one of several federal Health Care Reform laws that are creating a significant and immediate impact on employers. Regulations issued on February 2, 2010 prohibit group health plans that provide mental health and/or substance use disorder benefits (MHSA) from applying “financial requirements” or “treatment limits” that are more restrictive than the “predominant” financial requirement or treatment limit that applies to “substantially all” medical/surgical benefits.
Anthem Blue Cross is working to ensure the health plans we offer comply with the provisions contained in MHPAEA and have evaluated our plan designs using prescribed formulas. The following changes to mental health and substance abuse benefits are required to achieve financial parity with medical and surgical benefits under the new rules.
- In general, for HMO, there will be no cost share for Outpatient Mental Health and Substance Abuse services.
- In general, for PPO, the Inpatient and Outpatient cost share for Mental Health and Substance Abuse services should be equal to the majority of the plans cost share (coinsurance or no copay) for the specified benefit.
- All plans, residential treatment centers will not have an annual day maximum (e.g., 100 day limit listed under skilled nursing facility benefit).