Frequently Asked Questions on Mental Health Parity Rights under your Health Insurance Plan
Here are some questions and answers that the Connecticut Insurance Department hopes will help you to better understand your rights to mental health benefits under health plans.
1. What types of health insurance policies and plans are required to provide mental health benefits under Connecticut’s insurance laws and the ACA?
Connecticut’s mental health laws extend protections to Connecticut individual health insurance policies and fully insured Connecticut group health insurance policies of all sizes (small and large employers). Policies providing coverage for hospital expense coverage, medical-surgical expense coverage, and major medical expense coverage, as well as HMO hospital and medical coverage agreements, that are issued in Connecticut, must include these important safeguards.
Further, ACA requires, with limited exceptions, that individual and small employer health insurance plans must include ten Essential Health Benefits including mental health and substance use disorder services.
2. What benefits and protections must be provided in policies under Connecticut insurance laws?
Plans subject to Connecticut laws must contain two primary requirements:
- The policy must cover mental health benefits, meaning that mental health benefits cannot be excluded from the policy.
- The policy cannot establish any terms, conditions or benefits that place a greater financial burden on an individual to obtain mental health benefits than for diagnosis and treatment of medical benefits.
3. What conditions would not qualify as mental and nervous conditions under Connecticut insurance laws?
The following conditions are not covered:
- mental retardation
- learning disorders
- motor skills disorders
- communication disorders
- caffeine-related disorders
- relational problems
- additional conditions that may be a focus of clinical attention, that are not otherwise defined as mental disorders in the most recent edition of the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders.”
This information was originally published on ct.gov