It’s the law: Parity for mental health, substance abuse benefits
Not all changes in health benefits for 2012 arise from the new PS&T contract.
For instance, under the federal Mental Health Parity and Addiction Equity Act of 2008, health plans such as the Empire Plan must provide benefits for the treatment of mental health and substance abuse disorders in full parity with the benefits for other medical services.
That means financial requirements such as co-pays and deductibles cannot be higher, and treatment limitations cannot be greater for such things as the number or frequency of visits, and days of coverage cannot be more restrictive for mental health and substance abuse services than for other medical services.
So, starting January 1, you will have a shared deductible if you use a provider who is not in the Empire Plan network for medical/surgical, mental health and substance abuse benefits. The deductible will be $1,000 for the enrollee, $1,000 for the spouse or domestic partner and $1,000 for all dependent children combined.
You will continue to have a separate deductible if you use a provider who’s not in the network for managed physical medicine. That deductible will be $250 for the enrollee, $250 for the spouse or domestic partner and $250 for all dependent children combined.
In addition, the coinsurance maximums for using non-network providers will be shared for hospital, medical, surgical, mental health and substance abuse benefits. The annual coinsurance maximum will increase to $3,000 for the enrollee, $3,000 for the spouse or domestic partner and $3000 for all dependent children combined.
Under the terms of the 2011-2015 PS&T contract, these shared annual coinsurance maximums and deductibles will not go up every year. They will remain constant for the term of the contract.
— Deborah Stayman
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It’s the law: Parity for mental health, substance abuse benefits
Negotiated Changes to Health Benefits
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