Mental Health Parity in the States

2007

 

 

State

Statute/Code Citation

Relevant Bills

Covered Population *

Benefit

Policies

Exclusions

Alabama

Code of AL §§27-54-1 to 27-54-7 (G/I)

(2000)

 

§10-4-115 (health care service plans)

(2002)

 

§27-21A-23 (HMOs)

(2002)

2000: HB 677

 

 

 

2002: SB 293

Full Coverage

Mental illness: schizophrenia, schizophrenia form disorder, schizoaffective disorder, bipolar disorder, panic disorder, obsessive-compulsive disorder, major depressive disorder, anxiety disorders, mood disorders, and any condition or disorder involving mental illness, excluding alcohol and substance abuse that falls under mental disorders listed in the ICD.

Mandated Offering

Coverage for the treatment and diagnosis of mental illnesses under terms and conditions that are no less extensive than the benefits provided for medical treatment for physical illnesses.  Provisions for maximum benefits and coinsurance and limitations, deductibles, exclusions, and utilization review protocols must be consistent with the chapter.

Group, Individual, HMOs and health care service plans

Group health plans covering 50 or fewer employees

Alaska

No Parity Law

Arizona

AZ Rev. Stat. Ann. 20-2322

(1997)

 

Coverage Defined by Plan

Mental Illness

Mandated if Offered

Parity in aggregate annual and aggregate lifetime limits; co-payments, limits on the number of visits or days, and medical necessity criteria may be different

Group

Businesses with 50 or fewer employees; cost increase of 1% or more

Arkansas

AR Stat. §§23-99-501 to 511

(1997)

HB 1525/

Act 1020 of 1997

Full Coverage

Mental Illness and Developmental Disorders: Illnesses and disorders listed in the ICD and the DSM††.

Mandate (Group)

No differences (compared to benefits for other medical illnesses) with regard to duration or frequency of coverage, the dollar amount of coverage, or financial requirements.

 

Mandated Offering (Individual, small insurers)

Same coverage as above

Group

 

 

 

 

 

 

 

 

Individual, plans for small insurers

State employees, and businesses that anticipate a cost increase of more than 1.5%

California

CA Ins. Code § 10125

(1973)

 

Coverage Defined by Plan

Mental and nervous disorders

 

Mandated offering

 

Group

n/a

 

CA Ins. Code § 10144.5

(1999)

1999: AB 88

Limited Coverage

Severe mental illness: schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorders, panic disorder, obsessive-compulsive disorder, pervasive developmental disorder, anorexia nervosa, bulimia nervosa.  Children with one or more mental disorders other than a primary substance abuse disorder or developmental disorder.

Mandate

Coverage includes OP services, IP hospital services, partial hospital services, and prescription drugs, if the policy or contract includes coverage for prescription drugs.  Parity extends to maximum lifetime benefits, co-payments and coinsurance and individual and family deductibles.

Group, individual, HMO

n/a

Colorado

CO Rev. Stat. §§10-16-104(5-5.5)

(1992, 1997)

 

1997: HB 1192

 

2003: HB 1164

Coverage Defined by Plan

Mental illness excluding autism

 

 

 

 

 

 

 

 

Limited Coverage

Biologically-based mental illness, including schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, and obsessive compulsive disorder.

Mandate

45 IP days or 90 days of partial hospitalization.  $1,000 or 20 OP visits.  Co-payments and coinsurance may be different but cannot exceed 50% of the payment.  Deductibles may not differ from those for other conditions

 

 

Mandate (biologically based)

Coverage must be no less extensive than coverage for physical illness.

 

 

 

Group

 

 

 

Small employers providing coverage through a basic health benefit plan

 

 

 

§101-16-104.7

(Substance Abuse)

(2002)

2002: HB 1263/Ch. 208 of 2002

Substance abuse

Mandated If Offered

Plan must cover voluntary or court-ordered treatment

Group and individual

n/a

Connecticut

CT Gen. Stat.

§ 38a-488a and

§ 38a-514

(1999)

1999: HB 7032

Broad Coverage

All mental illnesses recognized by the most recent edition of the DSM, including addictive disorders.  Exceptions: mental retardation, learning disorders, motor skills disorders, communication disorders, caffeine-related disorders, relational problems and “additional conditions that may be the focus of clinical attention, that are not otherwise defined as mental disorders in the most recent addition” of the DSM.

Mandate

There may not be any terms, conditions or benefits that place a greater financial burden on an insured for access to diagnosis or treatment of mental or nervous conditions than for diagnosis or treatment of medical, surgical or other physical health conditions.

 

Group and individual

n/a

Delaware

DE Code Ann. Tit. 18 § 3343

(1998, 2001)

1998: HB 156

 

2001: HB 100

Limited Coverage

Serious mental illness: schizophrenia, bipolar disorder, obsessive-compulsive disorder, major depressive disorder, panic disorder, anorexia nervosa, bulimia nervosa, schizoaffective disorder and delusional disorder.  Drug and alcohol dependencies included in 2001.

Mandate

Coverage required under the same terms and conditions of coverage offered for physical illnesses.  No out of network coverage, benefit management may be different than for physical illnesses.

Group, individual, and HMO 

 

n/a

District of Columbia

DC ST § 31-3104

(1999, 2006)

Select “Update” at top of section

 

Full Coverage

Clinically significant mental illness: any psychiatric disease identified in the most recent edition of the ICD or the DSM.  Substance abuse included.

Mandate

Minimum benefits: 60 IP days; minimum rate of 75% for the first 40 OP visits and a minimum rate of 60% for any OP visits thereafter.

Group and individual

n/a

Florida

FL Stat. § 627.668

 

Full Coverage

Mental and nervous disorders as defined in the standard nomenclature of the American Psychiatric Association

Mandated Offering

Benefits (durational limits and dollar amounts) do not need to be the same as those for physical illness once minimum benefits are met.  Minimum benefits: 30 IP (including partial hospitalization) days and $1,000 in OP benefits

Group and HMO

n/a

Georgia

GA Code

§33-24-29

(Group- small employers)

 

 

 

 

 

 

 

 

 

 

§33-24-29.1

(Group- large employers)

 

 

 

 

§33-24-28.1

(Individual)

(1998)

1998: SB 620
Full Coverage
Mental disorders as defined by the DSM or the ICD, “or as the Commissioner may further define such term by rule and regulation.  Substance abuse included.

 

Mandated Offering

Group- small: Same degree of coverage and lifetime and annual dollar limits compared to physical illness.  Co-pays and co-insurance must also be equal, but IP days and OP visits may be different.  Separate deductibles and out-of-pocket maximums may be applied, but cannot be greater than those for medical/surgical benefits

 

Group- large: Same degree of coverage and lifetime and annual dollar limits compared to physical illness.  Co-pays, co-insurance, and visit limits must also be equal

 

Individual: Insurers not required to pay beyond 30 IP days and 48 OP visits.  Exclusions, reductions, or other limitations as to coverages,

deductibles, or coinsurance must also apply to similar benefits.

Group, individual and HMO

n/a

Hawaii

HI Rev. Stat. §431M to §431M-7

(1988, 1999, 2003, 2005)

1999: SB 844

 

2003: SB 1321

 

2005: SB 761

Broad Coverage

Mental illness: a syndrome of clinically significant psychological, biological, or behavioral abnormalities that results in personal distress or suffering, impairment of capacity for functioning, or both.  Does not include epilepsy, senility, mental retardation or other developmental disabilities.

 

 

 

 

 

 

 

 

 

 

Limited Coverage

Serious mental illness: a mental disorder consisting of at least one of the following:  schizophrenia, schizo-affective disorder, bipolar types I and II, delusional disorder, major depression, obsessive compulsive disorder, and dissociative disorder as defined in the most recent version of the DSM and which is of sufficient severity to result in substantial interference with the activities of daily living.

 

Substance abuse included in a separate section.

Mandate

Mental illness: Deductibles and co-payments must be equal to those for physical illnesses requiring a comparable level of care.  Minimum requirements: 30 IP days, partial hospitalization/day treatment at least 30 visits per year.  OP services for SA and MH: at least 24 per year.  At least 12 of those 24 visits must be for MH, not SA.  At least 2 treatment episodes for SA treatment per lifetime.

 

 

 

 

 

 

 

Serious mental illness: rates, terms, or conditions including service limits and financial requirements must be equal to those for medical/surgical conditions.

Group, individual, and HMO

Businesses with 25 or fewer employees

Idaho

ID Stat.: §67-5761A

2006: H.B. 615

Limited Coverage

Serious mental illness and serious emotional disturbances: Schizophrenia, Paranoia and other psychotic disorders, Bipolar disorders (mixed, manic, and depressive), Major depressive disorders (single episode or recurrent), Schizoaffective disorders (bipolar or depressive), Panic disorders, and Obsessive-Compulsive disorders.

Mandate

Services must be provided in a manner that: is not more restrictive or more generous than benefits and coverages

provided for other major illnesses; provides clinical care, but does not require partial care, of serious

mental illness or serious emotional disturbance; and is consistent with effective and common methods of controlling health care costs for other major illnesses.

 

 

 

Group, State employees only

n/a

Illinois

IL Rev. Stat. Ch. 215 Art. XX §5/370c (2nd version listed)

(1991, 2001, 2005)

2001: P.A. 092-0185

 

2005: P.A. 094-0584

 

2005: P.A. 094-0906

 

2005: P.A. 094-921

Coverage Defined by Plan

Mental, emotional, or nervous disorders

 

 

 

 

 

 

 

Limited Coverage

Serious Mental Illness: schizophrenia; paranoia and other psychotic disorders; bipolar disorders (hypomanic, manic, depressive, and mixed); major depressive disorders (single episode or recurrent); schizoaffective disorder (bipolar or depressive); pervasive developmental disorders; obsessive-compulsive disorders, depression in childhood and adolescence; panic disorder; post-traumatic stress disorder (acute, chronic, or with delayed-onset)

Mandated Offering

The insured may be required to pay up to 50% of expenses incurred as a result of the treatment or services, and the annual benefit limit may be limited to the lesser of $10,000 or 25% of the lifetime policy limit.

 

Mandate (SMI)

The coverage must provide for same durational limits, amount limits, deductibles, and co‑insurance requirements for serious mental illness as are provided for other illnesses and diseases.  Minimum of: 45 IP days and 60 OP visits.

 

Group and HMOs

 

Businesses with 50 or fewer employees

Indiana

IN Code § 27-13-7-14.8

(1999, 2001)

1999: HB 1108

 

2001: HB 1001

 

2003: HB 1135

Coverage Defined by Plan

Mental illness.  “Services for mental illnesses” as defined by a contract, policy, or plan for health services.   Substance abuse treatment for those with mental illnesses added in 2001.

Mandated if Offered

Treatment limitations and financial requirements must be equal to medical and surgical conditions.

Group, individual

Businesses with 50 or fewer employees, or a cost increase of 4% or more

 

IN Code § 5-10-8-9

(State Employee Plan, 1997)

 

Coverage Defined by Plan

Mental illness.  “Services for mental illnesses” as defined by a contract, policy, or plan for health services.   Substance abuse treatment for those with mental illnesses included.

Mandated if Offered

Treatment limitations and financial requirements must be equal to medical and surgical conditions.

State employees

Cost increase of 4% or more

Iowa

IA Code 514C.22

(2005)</