Definition


View in Glossary

Parity is about fairness. Americans with behavioral health conditions often have more difficulty getting the treatment and services they need when compared to individuals seeking other medical care. Explore parity-related information regarding legislation, statutes, and regulatory actions since the Federal Parity Law was passed in 2008.

Georgia Parity Law

There are several sections of the state insurance law relevant to parity. Three for behavioral health coverage and one for autism coverage:

It is not possible to provide direct links to any of these sections. To find them, click here. Then scroll down and click on the plus sign (+) next to “Title 33”. Then scroll down and click on the plus sign (+) next to “Chapter 24”. Then click on the plus sign (+) next to “Article 1. General Provisions”. Then scroll to the section you want from our list above.

Behavioral Health Coverage

Individual Plans

Individual plans are required to offer optional coverage for behavioral health services that is “at least as extensive” as coverage for other medical services.

Plans cannot have “any exclusions, reductions, or other limitations” or financial requirements for behavioral health services that are not in place for other medical services, except that plans must only cover 30 days of inpatient care and 45 visits for outpatient care.

Small Employer Fully-Insured Plans

Small employer fully-insured plans are required to offer optional coverage for behavioral health services “at least as extensive” as coverage for other medical services.

Annual maximums and lifetime maximums must be the same for behavioral health services and other medical services.

Plans cannot have “any exclusions, reductions, or other limitations” for behavioral health services that are not in place for other medical services, except that plans may limit days for inpatient care and visits for outpatient care. It does not specify any number for either of these limitations.

Except for deductibles, plans are allowed to have financial requirements for behavioral health services that are not in place or are different that those in place for other medical services.

Large Employer Fully-Insured Plans

Large employer fully-insured plans are required to offer optional coverage for behavioral health services “at least as extensive” as coverage for other medical services.

Annual maximums and lifetime maximums must be the same for behavioral health services and other medical services.

Plans cannot have “any exclusions, reductions, or other limitations” for behavioral health services that are not in place for other medical services, explicitly including limits for inpatient care and visits for outpatient care. It does not specify any number for either of these limitations.

Except for deductibles, plans are allowed to have financial requirements for behavioral health services that are not in place or are different that those in place for other medical services.

Autism Coverage

This section requires individual plans, small employer fully-insured plans with more than 10 employees, large employer fully-insured plans and state employee plans to cover autism services through age 6.

There is a $30,000 annual maximum for applied behavior analysis, but plans may not limit outpatient visits otherwise.

Plans can review a child’s treatment plan once a year.

Autism spectrum disorder is defined as it is in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.

Treatment of autism is defined as:

  • Habilitative or rehabilitative services
  • Counseling services provided by a licensed psychiatrist, licensed psychologist, professional counselor, or clinical social worker
  • Therapy services provided by a licensed or certified speech therapist, speech-language pathologist, occupational therapist, physical therapist, or marriage and family therapist

Plans can file for an exemption if they can prove that complying with this section of the law caused premiums to increase by 1% or more over a 12-month time span.

State Parity Reports

View the state parity reports to learn about legislation, regulation, and litigation related to parity implementation

State Parity Reports

Get Support

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.