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Compliance Assistance Resources

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- Health Benefits Advisor for Employers

Determining Compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) and Mental Health Parity Act (MHPA) Provisions in Part 7 of ERISA

Does the plan comply with the mental health parity provisions for annual dollar limits on mental health benefits?

A plan may not impose an annual dollar limit on mental health/substance use disorder benefits that is lower than the annual dollar limit imposed on medical/surgical benefits. See 29 CFR 2590.712(b). (Only limits on what the plan is willing to pay are taken into account.)

Tip: There is a different rule for cumulative limits other than aggregate lifetime or annual dollar limits, discussed later in this Advisor. A plan may impose annual dollar out-of-pocket limits on participants and beneficiaries if done in accordance with the rule regarding cumulative limits.