April 7, 2021
Treatment for mental health conditions, substance use disorders covered like physical illness
In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) to ensure equal coverage of treatment for mental illness and addiction. The federal government released rules to implement the law in 2013, which substantially improved coverage for mental health. Before the law, treatment for mental health conditions were typically at far lower levels in health insurance policies than for physical illness. The act aligns with the behavioral health pillar of the Healthy Boiler Program.
What is the Medical Health Parity and Addiction Equity Act?
The Mental Health Parity and Addiction Equity Act provides for parity in the application of aggregate treatment limitations (day or visit limits) on mental health and substance abuse benefits with day or visit limits on medical and surgical benefits. In general, group health plans offering mental health and substance abuse benefits cannot set day or visit limits on mental health or substance abuse benefits that are lower than any such day or visit limits for medical and surgical benefits. A plan that does not impose day or visit limits on medical and surgical benefits may not impose such day or visit limits on mental health and substance abuse benefits offered under the plan. Also, the plan may not impose deductibles, copayment/coinsurance and out-of-pocket expenses on mental health and substance abuse benefits that are more restrictive than deductibles, copayment/coinsurance and out-of-pocket expenses applicable to other medical and surgical benefits.
What does this mean for those covered?
Mental health parity and addiction equity means the equal treatment of mental health conditions and substance use disorders in insurance plans. When a plan has parity, which all of Purdue’s health plans do, it means that if a person can have unlimited doctor visits for a chronic condition such as diabetes, then the plan must also offer unlimited visits for a mental health condition such as depression or schizophrenia. In short, an individual’s health plan must treat mental health and addiction conditions the same as a medical condition.
Insurance coverage with Purdue health plans
Purdue’s health plan coverage for mental health conditions and substance use disorders includes medication, office visits, testing, in-patient treatment and outpatient treatment. In addition, Purdue’s prescription coverage does not specifically exclude any drug categories for mental health.
In-person and telehealth visits are both covered as part of Purdue’s plans.
LiveHealth Online behavioral health costs are as follows:
- $80 for therapist or social worker.
- $95 for psychology.
- $175 for psychiatry new patient visit.
- $75 for any follow up psychiatry visits.
Additionally, as long as the provider is in-network, any online behavior health visit (not just with LiveHealth Online) would be covered. The member will pay out of pocket until they meet their deductible.
To help employees find tier 1 (HealthSync) or tier 2 (in-network) behavioral health care providers, Human Resources has created a list of behavioral health referrals.
A breakdown of insurance coverage for alcohol or substance abuse and mental health is available as a PDF file.
Time off for mental health conditions and/or substance use disorders
Although the parity doesn’t apply to leaves, Purdue leaves pertain to time off if an employee is unable to work due to a mental health condition or substance use disorder; therefore, the employee may be eligible to apply for leave just the same as if they could not work due to a medical condition.
Questions can be directed to Human Resources at 765-494-2222, toll-free at 877-725-0222 or via email at firstname.lastname@example.org.