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

If the plan provides either mental health or substance use disorder benefits and medical and surgical benefits, the plan may be subject to the mental health parity provisions in Part 7 of ERISA.

Does the plan provide either mental health or substance use disorder benefits and medical and surgical benefits?

• Yes
• No. Return to the Advisor's introduction to learn about another health-care related provision of Part 7 of ERISA.

(Note, if under an arrangement(s) to provide medical care by an employer or employee organization, any participant or beneficiary can simultaneously receive coverage for medical/surgical benefits and mental health benefits, the mental health requirements apply separately with respect to each combination of medical/surgical benefits and mental health benefits and all such combinations are considered to be a single group health plan. See CFR 2590.712(e).) If this is the case, select "Yes" above.

Also, the plan may be exempt from the mental health parity provisions under the small employer (50 employees or fewer) exception or the increased cost exception. (To be eligible for the increased cost exception, the plan must have filed a notice with EBSA and notified participants and beneficiaries.) If the plan is exempt, select "No" above.

*NOTE: Any reference in this Advisor to mental health benefits includes both mental health and substance use disorder benefits.