Imagine your child is experiencing anxiety and depression and has suicidal thoughts. Or you are recovering from an eating disorder and need treatment at a residential facility. Then you’re told you have to pay deductibles and copayments that your workplace health coverage normally covers for other medical claims. Before you know it, these out-of-pocket costs are adding up to thousands of dollars you just don’t have.
Unfortunately, these are real scenarios that benefits advisors at the Labor Department’s Employee Benefits Security Administration have heard about recently.
But the good news for these workers – and you − is that a federal law called the Mental Health Parity and Addiction Equity Act provides protections. In most cases, the financial requirements (such as copayments, deductibles, coinsurance or out-of-pocket maximums) and treatment limitations in a health plan must be comparable for both physical and mental health/substance addiction benefits.
In these two cases, our benefits advisors contacted the workers’ benefit plans to make sure that they complied with the act. And both employer-provided plans agreed to pay the benefits to which the workers are legally entitled.
So what can you do to prevent this from happening to you?
Know your rights. The Department of Labor has several resources for workers and their families that explain how mental health parity works. You can find frequently asked questions and publications to help you learn more.
Learn more. In a recent webcast, Make the Most of Your Mental Health and Substance Use Disorder Benefits, we discussed the laws that affect these benefits. We also covered what information to request to help you determine which mental health or substance use disorder benefits may be available under your health plan. The webcast provided practical tips for submitting a mental health claim, including your rights to information and to appeal.
Ask us. If you are experiencing an issue with mental health or substance use disorder benefits through your private sector employer plan, contact one of EBSA’s benefits advisors at askebsa.dol.gov or toll free at 866-444-3272. If you have insurance through another source, this website has resources that explain how the parity laws apply to your health coverage.
We are here to help, but you can also be your own best advocate. This May during Mental Health Awareness Month, make the most of your mental health and substance use disorder benefits. Know your resources, know your rights, and know what to ask to get the benefits you are entitled to.
Mark Connor is the director of the Office of Outreach, Education and Assistance of the department’s Employee Benefits Security Administration.