labor lawAdivision of labor law center

Quietly and with little attention, 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 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.

This new ruling has a deep impact on Michigan employee benefit plans. Nationwide, in excess of 150 million workers are affected.

The regulation is called the Mental Health Parity Act, or MHPA, and is now extended until December 21 of 2007. The ruling comes down from the EBSA, or the U.S. Employee Benefits Security Administration. The EBSA is the watchdog agency requiring adherence to the regulations on health insurance.

To be legal, a health plan that puts a $250,000 limit, for example, on medical and surgical treatment must put the same maximum lifetime benefit on mental health care. Before passage of the original MHPA in 1996, coverage could have a quarter of a million dollar limit on medical care but only $15,000 on mental health care. Annual cops are covered by the same regulation. The annual or lifetime caps must be equal for either kind of treatment.

Typical mental health treatments would be stays in mental hospitals or mental health sections of medical hospitals for illnesses ranging from depression to schizophrenia or post-traumatic stress disorder. Visits to psychiatrists, licensed therapists, or psychologists are also covered.

The ruling continues a process begun after the law was originally passed. At that time there was a “sunset clause” which essentially ended the bill on September 31 of 2001. The law was amended five times after that to lengthen the expiration date.