labor lawAdivision of labor law center

With very little fanfare, a federal agency has passed a ruling applying to more than 150 million employees in the U.S. The ruling extends a law requiring that mental health coverage limits are equal to medical/surgical benefit limits in group insurance plans.

The law does not require that every Wisconsin employee benefit health plan must cover mental health treatments as well. What it requires is that, if a health plan offers mental health coverage, the benefit caps must equal those of the coverage for medical and surgical procedures.

The federal agency covers most businesses in the U.S. Its job is to guarantee that group insurance plans abide by laws controlling pensions and health plans. The MHPA became law in 1996, and since that time has been subject to five amendments extending it past its September 31, 2001 “sunset clause,” or expiration date.

The MHPA does not require employers to include mental health care coverage in their group insurance plans. It requires parity. In other words, if a group health insurance plan already has a mental health component, the benefit limits for that mental health portion must not be lower than those for medical and surgical coverage. Prior to enactment of the law, it would have been entirely legal for an insurance company to have a $250,000 limit as its absolute limit for surgery, but only a $15,000 limit for mental health care coverage. The law also impacts annual benefit caps. Under MHPA, mental health coverage limits must be the same as the lifetime or annual caps on surgery or medical care.

What’s included under the category of mental health treatments? Stays in rehabilitation facilities, or “rehabs” for treatment of alcohol or drug dependency are covered, as are visits to mental health professionals – licensed therapists, psychiatrists, and psychologists. Also included are stays in the mental health section of a medical hospital, or in mental hospitals themselves, for illnesses like schizophrenia, post-traumatic stress disorder, and depression.

There is nothing in the law requiring you as an employer to have a mental health component in your group health insurance program. It requires instead that, if you already have mental health coverage, its benefit limits must be equal to those of your plan’s medical or surgical treatment coverage.

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