labor lawAdivision of labor law center

Thanks to a ruling on group health insurance, South Dakota employee benefit plans will continue to include limits on coverage for mental health that equal those for medical and surgical procedures.

The ruling applies to what is known as the Mental Health Parity Act, or MHPA. As its name suggests, it declares that any employee group health plan in the nation must cover mental health treatment at levels equal to other kinds of medical treatment.

The law was recently extended through December 31 of 2007. The MHPA originally became law in 1996, but a so-called “sunset clause” was written into it, forcing its expiration on September 31 of 2001. But it has been extended five times by amendments since its creation. In excess of 150 million employees in the U.S. are covered by group health insurance packages, so the impact is wide-ranging.

The MHPA was a turning point. Until then, a health plan could put high limits on medical and surgical treatment, but much lower levels for coverage of mental health treatment issues.  While medical coverage limits might be at $100,000, mental health limits might be $10,000 or lower, sometimes as low as $5,000. Thanks to MHPA, that is illegal.

What is covered by mental health treatments? Typically, periods in drug and alcohol rehabilitation centers are included. Also covered are visits to a licensed therapist, a psychologist, or a psychiatrist, as well as stays in hospitals – mental health facilities or the mental health sections of medical hospitals for illnesses such as depression, schizophrenia, and post-traumatic stress disorder.

The Employee Benefits Security Administration (EBSA) enforces the law covering group health plans. It was first called the Pension and Welfare Benefits Program. In January of 1986, it became the Pension and Welfare Benefits Administration. Finally, in 2003 it received its EBSA title when it received an upgrade to sub-cabinet level, overseen by an Assistant Secretary of Labor. Its responsibilities now include monitoring health care law violations as well as pension law.