Definition


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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.

Utah Parity Law

There is one section of the state insurance law about behavioral health coverage and another section about autism coverage.

Behavioral Health Coverage

This section of the insurance law is about behavioral health coverage. Large employer fully-insured plans must offer optional behavioral health coverage that complies with the Federal Parity Law. Individual plans must cover behavioral health services and that coverage must comply with the Federal Parity Law.

There is contradictory language in this section about small employer fully-insured plans. A subsection of the law was added in 2014 that requires small employer fully-insured plans to cover behavioral health services and comply with the Federal Parity Law. Older subsections of the law do not require these plans to provide coverage for behavioral health services that complies with the Federal Parity Law. It is the opinion of ParityTrack that these older subsections are no longer relevant and they will not be summarized here. If you know or believe otherwise, please contact us at info@paritytrack.org.

Autism Coverage

Beginning on January 1, 2016 this section of the law requires individual plans and large employer fully-insured plans to cover autism services for children age 2 through age 9.

Plans must cover 600 hours per year of “behavioral health treatment”, which includes applied behavior analysis.

Deductibles, copayments, coinsurance, and annual limits must be the same for autism services as what are in place for other medical coverage.

Insurance plans can only review a child’s treatment plan once every 6 months.

Autism spectrum disorder is defined as “pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).”

Autism treatment is defined as:

  • Behavioral health treatment (applied behavior analysis )
  • Pharmacy care
  • Psychiatric care
  • Psychological care
  • Therapeutic care

Plans can be exempted from complying with section of the law if they can demonstrate that premium costs rose by at least 1% because of complying with this section.

National Parity Map

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

National Parity Map

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Common Violations

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