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.
Washington Parity Law
There are multiple sections of the state insurance law relevant to parity for mental health coverage and substance use disorder coverage. Some of these sections are virtually identical and have no meaningful differences. For the sake of simplicity, they will all be listed and hyperlinked here, and summarized below in the “Mental Health Coverage” and “Substance Use Disorder Coverage” sections. Any other sections relevant
to parity are linked within the summaries below.
This section authorizes the Washington State Office of the Insurance Commissioner to issue regulations regarding the sections of the insurance law relevant to parity.
Mental Health Coverage
These sections (links are above) require individual plans, small employer fully-insured plans, large employer fully-insured, public employee plans, plans offered by the Washington State Health Insurance Pool, and the Washington Basic Health Plan (currently not active) to cover all mental health services in the DSM with the exception of V codes and substance use disorders (other sections do require coverage for substance use disorders; these sections are summarized below).
These sections require the following of plans:
- Copayments and coinsurance must be the same for mental health services as what they are for other medical services
- Patients’ out-of-pocket costs for mental health services and other medical services must all go towards the same deductible
- Mental health services and other medical services must go towards the same out-of-pocket stop loss amount
- Treatment limitations and any other financial requirements not listed above must be the same for mental health services as they are for other medical services
- Prescription medication benefits for mental health treatment must be on “the same terms and conditions” as prescription medications for other medical treatment
Plans are allowed to use managed care, and there is no language saying that it must applied the same for mental health services as it is for other medical services.
Plans are exempted from covering residential treatment.
Substance Use Disorder Coverage
These sections of the law (linked above) require plans to cover services for substance use disorders as long as the services are part of an “approved treatment plan.” Approved treatment plan is defined as a “discrete program of chemical dependency treatment provided by a treatment program certified by the department of social and health services.”
- Washington Insurance Division