What are some of the protections under MHPAEA?

What are some of the protections under MHPAEA?

MHPAEA requires that insurers meet mental health parity standards in two areas: quantitative limits and non-quantitative limits.

  • Plans must apply comparable financial requirements (such as copay, coinsurance, & deductible) for mental health/substance use disorder and medical surgical care.
  • The number of outpatient visits or inpatient days covered must be comparable for mental health/substance use disorder and medical surgical care.  
  • Prior authorization requirements for mental health/substance use disorder services must be comparable to or less restrictive than those for medical surgical services.

These standards are applied according to classifications of benefits:

  • Inpatient / in-network
  • Inpatient / out-of-network
  • Outpatient / in-network
  • Outpatient / out-of-network
  • Emergency care
  • Prescription drugs

What are some of the protections under MHPAEA?