279 Enforcing Mental Health Parity 2015
the following benefits: hospitalization, outpatient hospital and clinical services (including emergency services), physician services, medical services,
preventive services, prescription drugs, rehabilitation services, maternity
care, baby and childcare for children twenty-one years and younger, early
and periodic screening, diagnosis and treatment for children up to age twenty-one, and most importantly, mental health, behavioral health, and substance abuse disorder services.209 If the selected benchmark package does
not cover a required category, the state is required to supplement the package with benefits from another source.210
Although all state EHB-benchmark plans covered MH and SU benefits,
the majority of states also placed treatment exclusions and limitations on
their coverage. This is permissible under the ACA, but “[c]urrently, annual
limits on the dollar value of EHBs are restricted and lifetime limits on the
dollar value of EHBs are prohibited.”211 The MHPAEA further requires that
these limits and exclusions be no more restrictive than the financial requirements and treatment limitations placed on the medical/surgical benefits covered by the health plan.
Appendix A explores the limits and exclusions each state placed on its
2012 EHB-benchmark plans with an emphasis on mental/behavioral health
and substance use disorder in- and out-patient benefits.
health benefit coverage in each state, and also set the standard for qualified health plans sold
in the health exchanges. See Grace et al., supra note 17 at manuscript 2136-37.
209. PPACA, 42 U.S. C. §18022 (West, Westlaw through P.L. 113-174 approved Sept.
26, 2014); see also 45 C.F.R. §156.110(b)(1) (West, Westlaw through Nov. 4, 2014; 79 FR
68087) (“ A base-benchmark plan that does not include items or services within one or more
of the categories described in paragraph (a) of this section must be supplemented . . . “).
210. NAT’L ASS’N OF INS. COMM’RS, supra note 13, at 9.
211. Id. at 10.
