What is the “Mental Health Parity and
Addiction Equity Act” and how does it affect me?
What is parity?
Parity is equal or fair treatment. The FAQs below outline how the
idea of parity is applied to mental health coverage by the Mental Health Parity
and Addiction Equity Act. After reading the information provided here, if you
still have questions about parity and how it applies to you, please visit our Consumer Services Bureau or call their hotline at
What is the Mental Health Parity and Addiction Equity
The Mental Health Parity and Addiction Equity Act of 2008
(MHPAEA) is a federal law that requires the same health insurance coverage for
mental health and/or substance use disorder (MH/SUD) conditions as patients
would receive for coverage of medical/surgical (M/S) services. This law was
adopted into Pennsylvania law in 2010. Historically, health care coverage for
MH/SUD treatment was not the same as coverage for M/S conditions. For example,
if coverage for mental health services was provided, often there were limits on
the number of visits and higher out-of-pocket costs than the same coverage for
medical and surgical services. The MHPAEA changed this requirement. Parity
(which means equal or fair treatment) requires insurance companies to administer
MH/SUD benefits in the same way as they administer M/S benefits: both the
quantitative limits, such as the visit limits or deductibles, as well as the
qualitative limits, such as prior authorization requirements and network
criteria, must be parallel.
Are insurance plans required to offer mental health and
substance abuse treatment?
It depends. Pennsylvania has a law,
referred to as Act 106, which requires minimum coverage for alcohol and
substance abuse treatment. See the FAQ on Act 106 below for more information.
Beyond Act 106, MHPAEA itself does not mandate insurance plans to offer mental
health or substance abuse treatment benefits. However, under the Affordable Care
Act, individual and small group plans must offer MH/SUD benefits. Large group
plans or self-funded plans are not required to offer MH/SUD benefits, but if one
of these plans does offer this coverage, the MH/SUD benefits must parallel the
Does the MHPAEA Apply to Me?
to persons enrolled in:
- Individual and small group health plans sold in the commercial
market beginning after January 1, 2014, as required by the Affordable Care Act
- Insurance plans issued by your employer, if your employer has
more than 50 employees, including self-insured as well as fully insured
arrangements, if the plan covers MH/SUD.
- CHIP and certain Medicaid plans (proposed rules regarding how
MHPAEA applies to these plans are pending).
What do these plans cover?
The MHPAEA prohibits health plans from providing MH/SUD benefits
that are more restrictive than the M/S benefits they offer, with respect to the
following coverage features:
- What you pay: Copays, coinsurance, deductibles, and
- How much treatment you can get: Limitations on services
utilization, such as limits on the number of inpatient or outpatient visits that
- The use of management tools, such as pre-authorization
- Which doctors you can see: coverage for out-of-network
- The criteria the insurance company uses to determine what is
considered medically necessary treatment.
How does MHPAEA interact with Pennsylvania Requirements
under Act 106?
Pennsylvania’s alcohol and substance use treatment
mandate law, known as Act 106, mandates certain minimum benefits. The Act 106
mandate is triggered if fewer days or treatment sessions are covered by your
plan or as required by the parity law, whether you have a large or small
group health insurance plan. (Act 106 does not apply to individual plans or to self-funded coverage.)
However, Act 106 only requires a minimum level of benefits. If
your plan offers M/S benefits that are more generous than the MH/SUD benefits
mandated by Act 106, you will be entitled to more generous MH/SUD benefits
because the parity law says they must still be parallel to those M/S benefits.
For example, Act 106 mandates coverage of 30 outpatient sessions for MH/SUD
services. If your plan covers 60 days of outpatient sessions for M/S services,
the parity law would require that plan to also cover 60 outpatient sessions for
What is typically covered under Act
- Up to seven days of detoxification per admission; four
admissions per lifetime (hospital or non-hospital inpatient
- A minimum of 30 days of residential treatment services per
year; 90 days per lifetime (non-hospital residential);
- Minimum of 30 sessions of outpatient/partial hospitalization
services per year; 120 sessions per lifetime (outpatient/partial
- Family counseling and intervention services;
- 30 additional outpatient/partial hospitalization sessions,
which may be exchanged on a two-to-one basis to provide 15 additional
non-hospital, residential treatment days, are also available.
These numbers of days or sessions would have to be covered in
Pennsylvania, even if the parity law provides fewer days or sessions of
coverage. As an example, consider someone needing outpatient alcohol
treatment. If the person’s group plan limited outpatient treatment for
medical/surgical reasons to 20 sessions per year, then under the parity law that
plan could have an equivalent 20 session limit on substance use disorder
outpatient treatment. However, because of , Act 106, that person would be
covered for 30 sessions of outpatient treatment per year.
Where can I learn more?
Remember, parity in
coverage for mental health and substance use disorder benefits with medical and
surgical benefits is the law! If you have questions about this, visit our Consumer Services Bureau or call their hotline at
To learn more, these additional websites also provide
information about Mental Health Parity: