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quantitative limitations

Last week Insurance Commissioner Teresa Miller reiterated to consumers that enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) is a priority for her department. Miller also encouraged consumers to understand what benefits they are entitled to under the law and to file complaints with the Insurance Department if they believe they are not getting proper insurance coverage. “The Pennsylvania Insurance Department takes this law very seriously, and we will us our statutory authority to enforce parity requirements on plans over which we have jurisdiction,” said Commissioner Miller.

The MHPAEA of 2008 requires health insurance plans to contain the same level of coverage for mental health and substance use disorders as for medical or surgical care. This coverage includes quantitative limitations (copays, deductibles, and limits on inpatient or outpatient visits that are covered) and non-quantitative limitations (pre-authorizations, providers available through a plan’s network, and what a plan deems “medically necessary”).

One important step toward a well-integrated system of health care, both physical and behavioral, is full implementation of the letter and spirit of MHPAEA. RCPA is actively working with health care advocates as part of the state’s Parity Coalition to assure consumers and providers/practitioners that Medicaid, CHIP, and private health plan coverage include quantitative and non-quantitative parity.

For more information on the MHPAEA or to file a complaint or ask a question, visit the insurance department website or call 877-881-6388.