Mental Health Parity Act of 1996 (HR3666)
Requirements - HR3666
- Who is covered?
- Employers with more than 50 employees
- What is the effective date?
- Plan year renewal on or after January 1, 1998
- What are my options?
- 1. Drop mental health coverage -- not a logical choice
- 2. Seek exemption -- must comply for at least 6 months
- 3. Comply with the mandate of the Act -- our recommendation
- What is the mandate of HR 3666?
- To adopt the same annual and lifetime dollar limits for mental health benefits that
apply to medical benefits
Recommended Plan Design
The following numbers will apply for Mental/Nervous Treatment* per plan year:
Inpatient Acute
|
14 Days
|
Inpatient Sub-acute
|
14 Days
|
Day Treatment/PHP
|
28 Days
|
Residential
|
40 Days
|
IOP
|
6 Weeks
|
Outpatient
|
50 Sessions
|
Additionally:
-
A plan co-payment of at least 80 percent for all levels of mental health treatment
should be provided for in-network.
-
If there are non-network benefits, the co-payment difference between network and
non-network should be at least 30 percent. Also, if non-network benefits are provided, the
plan document should state that those charges will be re-priced per a non-network fee
schedule and include a significant pre-certification penalty. For private employers under
ERISA, a plan design with no benefits (except in an emergency) for out-of-network
treatment should be considered by the employer.
For additional
information, or a custom proposal, please contact us.
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always has been, always
will be.
Providers
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