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 parity in classification of benefits?

• Yes
• No

If a plan provides mental health or substance use disorder benefits in any classification of benefits, mental health or substance use disorder benefits must be provided in every classification in which medical/surgical benefits are provided. See 29 CFR 2590.712(c)(2)(ii) (A).

In determining the classification in which a particular benefit belongs, a plan must apply the same standards to medical/surgical benefits and to mental health or substance use disorder benefits. See 29 CFR 2590.712(c)(2)(ii)(A).

Tip: This rule applies to out-of-network providers. If the plan does not contract with a network of providers, all benefits are out-of-network. If a plan that has no network imposes a financial requirement or treatment limitation on in-patient or outpatient benefits, the plan is imposing the requirement or limitation within classifications (inpatient, out-of-network or outpatient, out-of-network), and the rules for parity will be applied separately for the different classifications. See 29 CFR 2590.712(c)(2)(ii)(B).