Do I Have Coverage?

Your parity rights are determined by whether you get your insurance through your employer, your state’s health exchange marketplace, the government, or on your own. Most types of insurance plans have to follow the Federal Parity Law, but there are a few exceptions. If you are insured by your employer and unsure of which kind of plan you have, contact your employer's Human Resources department. If you purchase insurance yourself and are unsure of which kind of plan you have, contact your insurance provider.

Here are plans that are not covered by the Federal Parity Law:

  • Not Covered Small employer plans created before 3/23/2010
  • Not Covered Church-sponsored plans can opt out
  • Not Covered Tricare
  • Not Covered Medicare
  • Not Covered Fee-for-service Medicaid plans
  • Not Covered Retiree only plans
  • Not Covered Self-insured state & local government plans can opt out

What Are My Rights?

If your insurance plan is covered by the Federal Parity Law, you have specific rights.

Protection From Restrictive Financial Requirements

Under the Federal Parity Law, your insurance plan cannot have more restrictive financial requirements for behavioral health care than for other types of medical care. These financial requirements include:

Protection From Treatment Limits

Insurance plans are not allowed to have stronger limits on behavioral health treatment than other types of medical care. These limits are divided into two categories: Quantitative and Non-quantitative treatment limitations.

Quantitative treatment limitations are numerical limits placed on coverage of treatment. Examples of such limits are:

Non-quantitative treatment limitations. are limits on treatment that do not involve calculations. Some examples include:

  • Requiring permission to start treatment (Prior Authorization )
  • Requiring you to get permission to continue with your treatment
  • How your plan decides that your treatment is or is not medically necessary

  • Requiring that you try a less expensive treatment before you get the treatment your provider recommends (Fail First Protocol )

  • Requiring you to get treatment in your own state for behavioral health treatment but not other types of treatment

  • Limiting the prescription medications that are covered

If your insurance plan limits coverage differently for behavioral health care than for other medical care in any of these ways, it could be a violation of your parity rights.

Disclosure of Important Information

Your insurance plan has to send you written notice of the following:

  • Summary plan description about what benefits your insurance plan does and does not cover
  • An explanation of how your insurance determines and applies what is medically necessary

  • An explanation for any denial of treatment

Appeals

You always have the right to appeal a denial of treatment. There are several levels to the appeals process and it is important to be organized and follow the appeal rules very carefully. For more information on the appeals process, click here.

Get support in your state:

The Parity Implementation Coalition

  • info[at]mentalhealthparitywatch.org
  • 866-882-6227

Alabama Department of Insurance

Alaska Division of Insurance

Arizona Department of Insurance

Arkansas Insurance Department

California Department of Insurance

California Department of Managed Health Care

Psych Appeal

  • 8560 Sunset Boulevard Suite 500 West Hollywood, CA 90069
  • Psych Appeal Website
  • info[at]psych-appeal.com
  • (310) 598-3690

Colorado Department of Regulatory Agencies- Division of Insurance

Connecticut Insurance Department

Office of the Healthcare Advocate

Delaware Department of Insurance

Florida Office of Insurance Regulation

Office of Insurance and Safety Fire Commissioner

Hawaii Department of Commerce and Consumer Affairs

Idaho Department of Insurance

Illinois Department of Insurance

Indiana Department of Insurance

Angel Robinson: Iowa Insurance Consumer Advocate

Iowa Insurance Division

Kansas Insurance Department

Kentucky Department of Insurance

Louisiana Department of Insurance

Maine Bureau of Insurance

Maryland Insurance Administration

The Maryland Parity Project

Health Law Advocates

Massachusetts Division of Insurance

Michigan Department of Insurance and Financial Services

Minnesota Department of Commerce Insurance Division

Mississippi Insurance Department

Missouri Department of Insurance

Office of the Montana State Auditor, Commissioner of Securities and Insurance

Nebraska Department of Insurance

Nevada Department of Business and Industry- Division of Insurance

New Hampshire Insurance Department

New Jersey Department of Banking and Insurance

Office of Superintendent of Insurance, Managed Healthcare Bureau

Healthcare Bureau of the New York Office of the Attorney General

North Carolina Department of Insurance, Health Insurance Smart NC

North Dakota Insurance Department

Ohio Department of Insurance

Oklahoma Insurance Department

Oregon Insurance Division

Mental Health Association of Southeastern Pennsylvania

  • 1211 Chestnut Street # 1100, Philadelphia, PA 19107
  • anester[at]mhasp.org
  • 267-507-3340

Pennsylvania Insurance Department

RI Reach

South Carolina Department of Insurance

South Dakota Department of Labor and Regulation, Division of Insurance

Tennessee Department of Commerce and Insurance- Life and Health Unit

Mental Health America of Texas

Texas Department of Insurance

Utah Insurance Department

The Office of the Health Care Advocate

Vermont Department of Financial Regulation

Virginia Bureau of Insurance

Washington State Office of the Insurance Commissioner

West Virginia Offices of the Insurance Commissioner

State of Wisconsin Office of the Commissioner of Insurance