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5 Ways to Make the Most of Your Mental Health and Substance Use Disorder Benefits

A green ribbon for Mental Health Awareness Month with the text "Making the most of your mental health benefits."

The coronavirus pandemic not only attacked people’s physical health, but took a serious psychological toll, as well. This Mental Health Awareness Month, we want to make sure that workers who get health benefits through their employers understand what protections are available for mental health and substance use disorders.

Here are five tips to help you make the most of your mental health and other benefits:

  1. The Mental Health Parity and Addiction Equity Act provides important protections. Generally, it requires most health plans to apply similar rules to mental health and substance use disorder benefits as they do for physical health benefits.

  2. Check to make sure your health plan offers benefits for mental health and substance use disorders, sometimes called MH/SUD benefits. If your employer’s health plan offers coverage for MH/SUD benefits, then these protections apply. Review your summary of benefits and coverage and/or summary plan description to identify your benefits and your rights under the plan.

  3. Health plans must apply comparable copays and can’t impose separate deductibles and yearly visits, etc. for MH/SUD care and other medical services. For example, a health plan can’t impose a $30 copay for substance use disorder visits, but no copay for chiropractic visits.

  4. You are entitled to many documents related to your health plan’s MH/SUD and other medical benefits offered. For instance, if your plan only covers medically necessary treatments, you can request the plan’s medical necessity criteria for MH/SUD benefits, and information to verify the plan is applying the criteria in a comparable way. This protection also applies to requirements for prior authorization.

  5. If you suspect your health plan wrongfully denied a MH/SUD health claim, you have the right to request information about the limitation the health plan used to deny your claim and file an appeal.

For more information about the federal mental health and substance use disorder law visit our website. You can also contact a benefits advisor with your questions by visiting askebsa.dol.gov or calling 1-866-444-3272.

 

Ali Khawar is the acting assistant secretary of the U.S. Department of Labor’s Employee Benefits Security Administration.

 

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