Federal and State Parity Laws Tool

Find federal and state mental health parity laws on a state-by-state basis directly from state statutes covering health care and insurance.*

*The information in the Federal and State Parity Laws Tool summarizes state laws currently available on State legislature web sites. For a complete perspective on specific laws, copy and paste the URL listed in the Law Citation section for each state into your preferred search engine. SUNOVION MAKES NO WARRANTIES OR REPRESENTATIONS AS TO ITS ACCURACY, RELIABILITY, CURRENCY, AVAILABILITY OR COMPLETENESS.

Information up to date as of February 2018.

Federal and State Parity Laws

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  • Federal

    Law Summary

    The Mental Health Parity Act of 1996 (MHPA) provides that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits.

    The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) preserves the MHPA protections and adds significant new protections, such as extending the parity requirements to mental health and substance abuse disorders (MH/SUD). Although the law requires a general equivalence in the way MH/SUD and medical/surgical benefits are treated with respect to annual and lifetime dollar limits, financial requirements and treatment limitations, MHPAEA does NOT require large group health plans or health insurance issuers to cover MH/SUD benefits. The law’s requirements apply only to large group health plans and health insurance issuers that choose to include MH/SUD benefits in their benefit packages. However, the Affordable Care Act builds on MHPAEA and requires coverage of mental health and substance use disorder services as one of the Essential Health Benefit (EHB) categories in non-grandfathered individual and small group plans.

    Law Citation

    A final regulation implementing MHPAEA was published in the Federal Register on November 13, 2013. The regulation went into effect January 13, 2014 and generally applies to plan years (in the individual market, policy years) beginning on or after July 1, 2014. See http://www.gpo.gov/fdsys/pkg/FR-2013-11-13/pdf/2013-27086.pdf for the full text of the final regulation.

  • Alabama

    Law Summary

    Alabama requires large-employer fully insured plans to offer optional mental health coverage that large employers can accept or reject.

    Small employer plans (50 or fewer employees) and individual plans do not have to comply with this section of the insurance law.

    Section 27-54-4 includes all mental health conditions listed in the mental disorders section of International Classification of Diseases (ICD). It lists these conditions: 

    • Schizophrenia, schizophreniform disorder, schizoaffective disorder
    • Bipolar disorder
    • Panic disorder
    • Obsessive-compulsive disorder
    • Major depressive disorder
    • Anxiety disorders
    • Mood disorders

    However, the statute states that alcoholism and other drug dependencies are excluded.

    Section 27-54-3 specifies that inpatient services, outpatient services and partial hospitalization are included.

    These services must be on “terms and conditions that are no less extensive” than other medical services.

    Section 27-54-4 states that insurance plans must “use the same criteria” for medical necessity for mental health treatment as they use for other medical treatment. 

    The state requires each plan affected by section 27-54-6 to file an annual cost report with the Commissioner of Insurance that includes “certification of parity in mental health benefits and total annual costs of mental health services relative to total health costs.”

    Law Citation

  • Alaska

    Law Summary

    Alaska requires small-employer fully insured plans and large-employer fully insured plans to “comply with the mental health or substance use disorder benefit requirements established” by the Mental Health Parity and Addiction Equity Act of 2008.

    Law Citation

    Sec. 21.54.151. Mental health or substance use disorder benefits. http://www.legis.state.ak.us/basis/statutes.asp?year=2015&title=21#21.54.151

  • Arkansas

    Law Summary

    Except for certain exclusions listed in §23-99-504, Arkansas law requires health plans providing mental benefits to do so under the same terms and conditions as provided for covered benefits offered under the health benefit plan for the treatment.

    However, the law does not:

    (1) Require equal coverage between treatments for a mental illness with coverage for preventive care

    (2) Prohibit a health care insurer from:

    (A) Negotiating separate reimbursement rates and service delivery systems, including without limitation a carve-out arrangement; 

    (B) Managing the provision of mental health benefits for mental illnesses by common methods used for other medical conditions, including without limitation preadmission screening, prior authorization of services, or other mechanisms designed to limit coverage of services or mental illnesses to mental illnesses that are deemed medically necessary; 

    (C) Limiting covered services to covered services authorized by the health benefit plan, if the limitations are made in accordance with this subchapter;

    (D) Using separate but equal cost-sharing features for mental illnesses; or

    (E) Using a single lifetime or annual dollar limit as applicable to other medical illness; and

    (3) Include a Medicare or Medicaid plan or contract or any privatized risk or demonstration program for Medicare or Medicaid coverage. 

    Law Citation

  • Arizona

    Law Summary

    Mental health parity only applies to large-employer fully insured plans. Large-employer fully insured plans are not required to cover mental health services. If they do, annual maximums and lifetime maximums 1) are not allowed if not in place for substantially all health services or health benefits that are not related to mental health services or mental health benefits, and 2) if the health benefits plan includes a limit on substantially all health services or benefits that are not related to mental health, the plan shall either apply the limit equally OR not include any aggregate annual limit on mental health services or mental health benefits that is less than the applicable annual limit for health services or mental health benefits.

    Law Citation

    20-2322. Mental health services and benefits; definitions.
    http://www.azleg.gov/FormatDocument.asp?inDoc=/ars/20/02322.htm&Title=20&DocType=ARS

  • California

    Law Summary

    California's Health and Safety Code requires every health plan that provides hospital, medical, or surgical coverage shall provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and of serious emotional disturbances of a child, under these same terms and conditions applied to other medical conditions: maximum lifetime benefits, copayments, and individual and family deductibles. 

    These terms and conditions apply to the following benefits: outpatient services, inpatient hospital services, partial hospital services, and prescription drugs, if the plan contract includes coverage for prescription drugs.

    Individual plans, small and large-employer fully insured plans must offer coverage for the following severe mental illnesses: 

    1. Schizophrenia
    2. Schizoaffective disorder
    3. Bipolar disorder (manic-depressive illness)
    4. Major depressive disorders
    5. Panic disorder
    6. Obsessive-compulsive disorder
    7. Pervasive developmental disorder or autism
    8. Anorexia nervosa
    9. Bulimia nervosa

    Law Citation

  • Colorado

    Law Summary

    Colorado state law requires large-employer fully insured plans, small-employer fully insured plans, and individual plans to provide coverage for the following biologically based mental illnesses and mental disorders that is "no less extensive than coverage provided for a physical illness":

    Biologically based mental illnesses

    • schizophrenia 
    • schizoaffective disorder
    • bipolar affective disorder
    • major depressive disorder
    • specific obsessive-compulsive disorder
    • panic disorder



    Behavioral health, mental health, and substance abuse disorders

    • post-traumatic stress disorder
    • substance abuse disorders
    • dysthymia
    • cyclothymia
    • social phobia
    • agoraphobia with panic disorder
    • anorexia nervosa
    • bulimia nervosa
    • general anxiety disorder 
    • autism spectrum disorders, as defined in subsection (1.4)(a)(III) of this section


    Colorado law also allows a carrier to require prior authorization and utilization review in the same manner that they are required for hospitalization for other covered diseases or conditions.

    Law Citation

    10–16–104. Mandatory coverage provisions - definitions - rules.

    It is not possible to provide direct links to Colorado state law. Please follow these instructions to find section 10-16-104:

    • Click http://www.lexisnexis.com/hottopics/colorado/
    • Click on “Colorado Revised Statutes”
    • Click on the plus sign next to “Title 10”
    • Click on the plus sign next to “health care coverage”
    • Click on the plus sign next to “article 16”
    • Click on the plus sign next to “part 1”
    • Click on “10-16-104 mandatory coverage provisions”
  • Connecticut

    Law Summary

    Connecticut has 2 sections of its insurance law related to parity: 1) for individual plans and 2) for small-employer fully insured plans and large-employer fully insured plans.

    Both sections are identical except for referring to the type of applicable insurance. 

    Connecticut requires insurance plans to cover all behavioral health conditions in the Diagnostic and Statistical Manual of Mental Disorders (DSM) except for the following: 

    (1) Intellectual disabilities

    (2) Specific learning disorders

    (3) Motor disorders

    (4) Communication disorders

    (5) Caffeine-related disorders

    (6) Relational problems

    (7) Other conditions that may be a focus of clinical attention, that are not otherwise defined as mental disorders in the most recent edition of the American Psychiatric Association's DSM

    Insurance plans are forbidden from using “any terms, conditions or benefits that place a greater financial burden” on plan enrollees for behavioral health coverage than they do for treatment of medical, surgical, or other physical health conditions. 

    Law Citation

    Sec. 38a-488a. Mandatory coverage for the diagnosis and treatment of mental or nervous conditions. Exceptions. Benefits payable re type of provider or facility. State’s claim against proceeds. https://www.cga.ct.gov/current/pub/chap_700c.htm#sec_38a-488a

    Sec. 38a-514. Mandatory coverage for the diagnosis and treatment of mental or nervous conditions. Exceptions. Benefits payable re type of provider or facility. State’s claim against proceeds.
    https://www.cga.ct.gov/current/pub/chap_700c.htm#sec_38a-514

  • Delaware

    Law Summary

    Delaware requires individual plans, small-employer fully insured plans, and large-employer fully insured plans to cover services for the following conditions, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM): 

    • Schizophrenia
    • Bipolar disorder
    • Obsessive-compulsive disorder  
    • Major depressive disorder
    • Panic disorder 
    • Anorexia nervosa 
    • Bulimia nervosa 
    • Schizo affective disorder
    • Delusional disorder 
    • Drug and alcohol dependencies  


    Deductibles, co-pays, monetary limits, co-insurance factors, limits in the number of visits, limits in the length of inpatients stays, durational limits or limits in the coverage of prescription medicines for the listed behavioral health conditions must not "place a greater financial burden on an insured for covered services provided" than those in place for other medical services. 

    Management of benefits for serious mental illnesses, along with drug and alcohol dependencies, may be by management methods unique to mental health benefits.

    These sections do not apply to out-of-network behavioral health services not mentioned within statute.

    These sections shall not apply to plans or policies not within the definition of health benefit plan, including accident-only, credit, dental, vision, Medicaid plans, long-term care or disability income insurance, coverage issued as a supplement to liability insurance, worker's compensation or similar insurance or automobile medical payment insurance.

    Law Citation

    Individual Insurance Plans

    §3343 Insurance coverage for serious mental illness. http://delcode.delaware.gov/title18/c033/index.shtml#3343

    Employer plans

    §3578 Insurance coverage for serious mental illness. http://delcode.delaware.gov/title18/c035/sc04/index.shtml#3578

    Large-Employer Fully Insured Plans

    §3576 Mental health parity. http://delcode.delaware.gov/title18/c035/sc04/index.shtml#3576

  • Florida

    Law Summary

    Florida requires small-employer fully insured plans and large-employer fully insured plans to offer optional coverage for mental and nervous disorders. 

    If an employer chooses this optional coverage, the following is required:

    • No less than 30 days of inpatient benefits for mental health treatment with the same quantitative durational limits, dollar amounts, and coinsurance factors used for other medical services  
      • After 30 days, plans do not have to apply the same durational limits, dollar amounts, and coinsurance factors as applicable to physical illness generally
    • An annual maximum of $1,000 for outpatient benefits
      • Any coverage provided beyond $1,000 does not have to apply the same durational limits, dollar amounts, and coinsurance factors as coverage for physical illness generally 
    • The benefits for partial hospitalization services or a combination of inpatient and partial hospitalization may not exceed the cost of 30 days after inpatient hospitalization for psychiatric services, including physician fees  

    Law Citation

  • Georgia

    Law Summary

    Georgia's state insurance law addresses parity for individual plans, small-employer fully insured plans, and large-employer fully insured plans. 

    For Individual Plans

    Individual plans are required to offer optional coverage for behavioral health services “at least as extensive as treatment of other types of physical illnesses." 

    Plans cannot have “any exclusions, reductions, or other limitations” or financial requirements for behavioral health services not in place for other medical services, except that plans must only cover 30 days of inpatient care and 48 visits for outpatient care.

    For 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 treatment of physical illnesses.

    Annual and lifetime dollar limits must be the same for behavioral health services and treatment of physical illnesses. 

    Plans cannot have “any exclusions, reductions, or other limitations” for behavioral health services not in place for treatment of physical illnesses, except plans may limit days for inpatient care and visits for outpatient care. 

    Except for deductibles, plans are allowed to have financial requirements for behavioral health services that are not in place, or are different from those in place, for treatment of physical illnesses. 

    For 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 treatment of physical illnesses.

    Annual and lifetime dollar limits must be the same for behavioral health services and the treatment of physical illnesses. 

    Plans cannot have “any exclusions, reductions, or other limitations” for behavioral health services not in place for the treatment of physical illnesses, including limits for inpatient care and visits for outpatient care. 

    Except for deductibles, plans are allowed to have financial requirements for behavioral health services that are not in place, or are different from those in place, for treatment of physical illnesses.

    Law Citation

    For Individual Plans

    §33-24-28.1. Coverage of treatment of mental disorders.

    • Click http://www.lexisnexis.com/hottopics/gacode/Default.asp
    • Scroll down and click on the plus sign (+) next to “Title 33”
    • Scroll down and click on the plus sign (+) next to “Chapter 24”
    • Click on the plus sign (+) next to “Article 1. General Provisions”
    • Scroll to section §33-24-28.1

    For Small-Employer Fully Insured Plans

    §33-24-29. Coverage for treatment of mental disorders under accident and sickness insurance benefit plans providing major medical benefits covering small groups; federal law.

    • Click http://www.lexisnexis.com/hottopics/gacode/Default.asp
    • Scroll down and click on the plus sign (+) next to “Title 33”
    • Scroll down and click on the plus sign (+) next to “Chapter 24”
    • Click on the plus sign (+) next to “Article 1. General Provisions”
    • Scroll to section §33-24-29

    For Large-employer Fully Insured Plans

    §33-24-29.1. Coverage for mental disorders under accident and sickness insurance benefit plans providing major medical benefits covering all groups except small groups.

    • Click http://www.lexisnexis.com/hottopics/gacode/Default.asp
    • Scroll down and click on the plus sign (+) next to “Title 33”
    • Scroll down and click on the plus sign (+) next to “Chapter 24”
    • Click on the plus sign (+) next to “Article 1. General Provisions”
    • Scroll to section §33-24-29.1
  • Hawaii

    Law Summary

    Hawaii requires individual plans, small-employer fully insured plans, and large-employer fully insured plans to cover behavioral health conditions, with no exclusions listed.

    The state forbids plans from using any financial requirements, quantitative treatment limitations, and non-quantitative treatment limitations for behavioral health services more restrictive than those in place for other medical and surgical benefits. 

    Hawaii requires inpatient care, residential treatment, and partial hospitalization for mental health services. 

    In-hospital and nonhospital residential mental health services shall be provided in a hospital or a nonhospital residential facility.

    Mental health partial hospitalization shall be provided by a hospital or a mental health outpatient facility.

    Law Citation

  • Idaho

    Law Summary

    There has been no parity legislation in Idaho since the passage of the Mental Health Parity and Addiction Equity Act of 2008. Idaho’s parity law only applies to state government employees and their spouses and children. It covers the following conditions:

    1. Schizophrenia 
    2. Paranoia and other psychotic disorders 
    3. Bipolar disorder (mixed, manic, and depressive)
    4. Major depressive disorders (in single episode or recurrent)
    5. Schizoaffective disorder (bipolar or depressive)
    6. Panic disorder 
    7. Obsessive-compulsive disorders 


    Insurance plans for state government employees must provide coverage for these conditions "in a manner that is equitable and commensurate" with that provided for other major physical illnesses. 

    The law also requires plans for state government employees to provide coverage for children with “serious emotional disturbances,” defined as "emotional or behavioral disorder, or a neuropsychiatric condition which results in a serious disability, and which requires sustained treatment interventions, and causes the child’s functioning to be impaired in thought, perception, affect or behavior," as defined in section 16-2403, Idaho Code.

    Coverage must be not more restrictive or more generous than benefits and coverages provided for other major illnesses. 

    Law Citation

    67-5761A. Mental Health Parity in State Group Insurance.
    http://legislature.idaho.gov/idstat/Title67/T67CH57SECT67-5761A.htm

  • Illinois

    Law Summary

    Illinois state law requires individual plans, small-employer fully insured plans, and large-employer fully insured plans providing coverage for behavioral health services to ensure that financial requirements and treatment limitations for behavioral health services are no more restrictive than those in place for other medical services. 

    Plans cannot use annual maximums and lifetime maximums for behavioral health services, or have annual limits and lifetime limits if not in place for other medical services. 

    If a plan does have these in place for other medical services, they can do either of the following:

    • Ensure both behavioral health services and other medical services count towards combined limits and maximums
      OR
    • Make the limits and maximums for behavioral health services no less than those for other medical services. 


    For plans with many different limits and maximums for different categories of medical care, the law requires the Director of the Illinois Department of Insurance to use a mathematical formula to decide what the limits and maximums should be for behavioral health services. 

    Plans are required to follow the final regulations about the Federal Parity Law.

    Large-employer fully insured plans are required to cover substance use disorders and “serious mental illness,” defined as:

    1. Schizophrenia 
    2. Paranoid and other psychotic disorders 
    3. Bipolar disorders (hypomanic, manic, depressive, and mixed) 
    4. Major depressive disorders (single episode or recurrent) 
    5. Schizoaffective disorders (bipolar or depressive) 
    6. Pervasive developmental disorders 
    7. Obsessive-compulsive disorders 
    8. Depression in childhood and adolescence 
    9. Panic disorder 
    10. Post-traumatic stress disorders (acute, chronic, or with delayed onset) 
    11. Eating disorders, including but not limited to, anorexia nervosa and bulimia nervosa pica, rumination disorder, avoidant/restrictive food intake disorder, other specified feeding or eating disorder (OSFED), and any other eating disorder contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association


    Regarding medical-necessity review, the law states if there is a dispute between an insurance plan and the patient’s provider about whether a certain treatment is medically necessary, a review will be made by another provider in the same specialty as the patient’s provider. This provider will be jointly selected by the patient, the patient’s provider, and the insurance plan.

    The law also requires large-employer fully insured plans to cover no less than 45 days of inpatient care and 60 visits of outpatient care for serious mental illness, no matter what coverage is in place for other medical care. If a small-employer fully insured plan covers serious mental illness or any other behavioral health condition, they must abide by these visit and day coverage floors.

    The law prohibits any lifetime limits for the number of days of inpatient treatment or the number of outpatient visits covered under the plan.

    Law Citation

    Sec. 370c. Mental and emotional disorders.
    http://ilga.gov/legislation/ilcs/fulltext.asp?DocName=021500050K370c

    Sec. 370c.1. Mental health and addiction parity.
    http://ilga.gov/legislation/ilcs/fulltext.asp?DocName=021500050K370c.1

  • Indiana

    Law Summary

    Indiana law states that plans offering behavioral health coverage cannot use treatment limitations and financial requirements if similar treatment limitations and financial requirements are not used for other medical coverage.

    Law Citation

    IC 27-13-7-14.8. Treatment limitations or financial requirements on coverage of services for mental illness.
    https://iga.in.gov/static-documents/c/a/9/a/ca9a3a9e/TITLE27_AR13_ch7.pdf

    IC 27-8-5-15.6. Treatment limitations or financial requirements on coverage of services for mental illness.
    https://iga.in.gov/static-documents/0/4/7/9/04799295/TITLE27_AR8_ch5.pdf

    IC 5-10-8-9. Coverage of services for mental illness. http://iga.in.gov/static-documents/5/3/e/b/53eb9035/TITLE5_AR10_ch8.pdf

  • Iowa

    Law Summary

    Iowa requires large-employer fully insured plans to cover services for the following conditions: 

    • Schizophrenia 
    • Bipolar disorders 
    • Major depressive disorders 
    • Schizo-affective disorders 
    • Obsessive compulsive disorders 
    • Pervasive developmental disorders 
    • Autistic disorders 


    Small-employer fully insured plans are not required to cover any mental health treatment, but if they do they must cover services for those conditions.

    Plans cannot use annual maximums and lifetime maximums for mental health coverage if they are not in place for other medical coverage. 

    If they do have annual and lifetime maximums in place for other medical coverage, the ones used for mental health services cannot be less than the ones for other medical coverage. 

    Plans must cover at least 30 days of inpatient care and 52 visits for outpatient care annually. 

    Deductibles, coinsurance, and copayments must be provided to the same extent as deductibles, coinsurance, and copayments are applied to other health, medical, or surgical services under the policy.

    Law Citation

    514C.22. Biologically based mental illness coverage. https://www.legis.iowa.gov/docs/code/514C.22.pdf

  • Kansas

    Law Summary

    For plans that are not small-employer fully insured plans or individual plans, Kansas law requires coverage for behavioral health services, and all financial requirements and treatment limitations are the same as what the plans have in place for other medical services. 

    • The law defines treatment limitations as “limits on the frequency of treatment, number of visits, days of coverage or other similar limits on the scope or duration of treatment” 
    • Treatment limitations apply to inpatient and outpatient care for mental illness, alcoholism, drug abuse or substance use disorders
    • Any mental illness or substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders is covered 


    For small-employer fully insured plans and individual plans, Kansas law requires coverage for at least 45 days of inpatient care for mental illness and 30 days of inpatient care for substance use disorders.

    • Financial requirements for inpatient care must be the same as those used for other inpatient medical care 
    • Small-employer fully insured plans and individual plans are not required to cover outpatient care 

    Law Citation

    40-2,105a. Kansas mental health parity act; insurance coverage for services rendered in the treatment of mental illnesses, alcoholism, drug abuse or substance use disorders; limitations.
    http://www.kslegislature.org/li/m/statute/040_000_0000_chapter/040_002_0000_article/040_002_0105a_section/040_002_0105a_k.pdf

    40-2,105. Insurance coverage under individual or small employer group policies for services rendered in treatment of mental illness, alcoholism, drug abuse or substance use disorders; limitations; exceptions.
    http://www.kslegislature.org/li/m/statute/040_000_0000_chapter/040_002_0000_article/040_002_0105_section/040_002_0105_k.pdf

  • Kentucky

    Law Summary

    The parity law affecting large-employer fully insured plans defines "Mental health condition" as any condition or disorder that involves mental illness or alcohol and other drug abuse as defined in KRS 222.005 and that falls under any of the diagnostic categories listed in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) or that is listed in the mental disorders section of the International Classification of Disease, or the most recent subsequent editions. 

    Terms and conditions include:

    • Day or visit limits
    • Annual payment limits and lifetime payment limits
    • Deductibles
    • Copayments and coinsurance
    • Prescription coverage
    • Out-of-pocket limits and any other cost-sharing requirements


    “Treatment of a mental health condition” is defined as including inpatient care, any necessary outpatient care, partial hospitalization, residential treatment, crisis stabilization, and emergency detoxification.

    Kentucky requires group plans to offer optional coverage for mental illness, which include psychosis, neurosis, or an emotional disorder. 

    This coverage should include inpatient and outpatient treatment of mental illness and must be "at least to the same extent and degree" as coverage for treatment of physical illnesses. 

    Individual Plans

    Kentucky requires individual plans to offer optional coverage for mental health illnesses. This coverage should include inpatient treatment and outpatient treatment and must be "at least to the same extent and degree" as coverage for other medical care.

    Law Citation

    304.17A-660 Definitions for KRS 304.17A-660 to 304.17A-669. http://www.lrc.ky.gov/Statutes/statute.aspx?id=29324

    304.17-318 Coverage for treatment for mental illness. http://www.lrc.ky.gov/Statutes/statute.aspx?id=17330

    304.18-036 Coverage for treatment for mental illness. http://www.lrc.ky.gov/Statutes/statute.aspx?id=29424

  • Louisiana

    Law Summary

    Louisiana law requires large-employer fully insured plans, small-employer fully insured plans, other group plans, and self-insured plans (except those exempted by ERISA) to cover the following mental health conditions: 

    • Schizophrenia or schizoaffective disorder 
    • Bipolar disorder 
    • Panic disorder 
    • Obsessive-compulsive disorder 
    • Major depressive disorder 
    • Anorexia/bulimia 
    • Intermittent explosive disorder 
    • Posttraumatic stress disorder
    • Psychosis not otherwise specified when diagnosed in children under seventeen years of age 
    • Rett’s Disorder
    • Tourette’s Disorder  


    This coverage shall include benefits payable for treatment "under the same circumstances and conditions or greater" as coverage for other medical conditions. 

    Plans must cover at least:

    • 45 days of inpatient care per covered individual per calendar year
    • 52 outpatient visits per covered individual per calendar year  


    Enrollees can exchange each day of inpatient care for 4 outpatient visits or 2 days of either residential treatment or partial hospitalization, or vice versa. 

    Large-employer fully insured plans must comply with the following regarding aggregate lifetime limits and annual limits:

    • Plans cannot use annual maximums for mental health services if they are not in place for other medical services.
    • If a plan does have these in place for other medical services, they can do either of the following:
      • Make it so that both behavioral health services and other medical services count towards combined maximums 
        OR
      • Make the maximums for mental health services no less than the ones in place for other medical services 
    • For plans that have many different maximums for different categories of medical care, the law requires plans to use a mathematical formula involving the weighted averages of these annual and lifetime maximums to decide what the limits and maximums should be for mental health services. 
    • Plans are exempt from this section if complying with it causes premium costs to increase by 1% in any year. 

    Law Citation

    §1043. Severe mental illness and other mental disorders; policy provisions; minimum requirements; group, blanket, and association policies.
    http://www.legis.la.gov/legis/Law.aspx?d=507883

    §1066. Parity in the application of certain limits to mental health benefits.
    http://www.legis.la.gov/legis/Law.aspx?d=507898

  • Maine

    Law Summary

    Maine requires large-employer fully insured plans and small-employer fully insured plans with 21 or more employees to cover “medically necessary health care for a person suffering from mental illness,” including inpatient care, outpatient care, partial hospitalization, and home health services. 

    Additional coverage requirements apply for treatment of the following behavioral health conditions:

    • Psychotic disorders, including schizophrenia 
    • Dissociative disorders 
    • Mood disorders 
    • Anxiety disorders 
    • Personality disorders 
    • Paraphilias
    • Attention deficit and disruptive behavior disorders  
    • Pervasive developmental disorders 
    • Tic disorders
    • Eating disorders, including bulimia and anorexia  
    • Substance abuse-related disorders


    For these conditions, services must be covered on “terms and conditions no less extensive” than services for other medical conditions.  

    Additional requirements include:

    • Plans cannot have annual maximums, lifetime maximums, deductibles, coinsurance amounts, and other out-of-pocket yearly dollar limits that are different from those used for other medical services 
    • Plans cannot have different visit limits for outpatient care for behavioral health services 
    • Copayments cannot be greater for behavioral health services than those used for other medical services 
    • Medical necessity determinations for behavioral health coverage must follow the same criteria as what is in place for other medical coverage 
    • Coverage of office visits for medication management must be the same for behavioral health treatment and other medical treatment 


    Maine requires small-employer fully insured plans with 20 or fewer employees and individual plans to offer optional mental health coverage for the following conditions: 

    • Schizophrenia
    • Bipolar disorder 
    • Pervasive developmental disorder, or autism  
    • Paranoia
    • Panic disorder 
    • Obsessive-compulsive disorder  
    • Major depressive disorder


    Maine requires plans to do the following if the plan covers the above conditions:

    • Coverage for mental health services must be "under terms and conditions that are no less extensive" than the benefits provided for medical treatment for physical illnesses
    • Medical-necessity determinations for mental health coverage must follow the same criteria as what is in place for other medical coverage 
    • File an annual report with the Maine Bureau of Insurance about the cost of covering these conditions broken into cost by inpatient care, outpatient care, and partial hospitalization 

    Law Citation

    §2843. Mental health services coverage.
    http://legislature.maine.gov/statutes/24-A/title24-Asec2843.html

    §2843(5-D). Mandated offer of coverage for certain mental illnesses.
    http://legislature.maine.gov/statutes/24-A/title24-Asec2843.html

  • Maryland

    Law Summary

    Maryland requires large-employer fully insured plans, small-employer fully insured plans, and individual plans to provide coverage for behavioral health services under the "same terms and conditions" as other medical services with no exempted conditions with the exception of small employer grandfathered health plan coverage. 

    The state requires plans to comply with certain sections of the Mental Health Parity and Addiction Equity Act of 2008, including those that address financial requirements, quantitative treatment limitations, and non-quantitative treatment limitations (NQTLs).

    The law states that plans must cover the following services for behavioral health treatment at the same level as they cover these services for other medical treatment: 

    • Inpatient care 
    • Partial hospitalization (no less than 60 days) 
    • Outpatient care 


    “Processes, strategies, evidentiary standards, or other factors used to determine coverage” for behavioral health coverage cannot be “applied more stringently” than they are for other medical coverage. 

    The benefits required under this section may be delivered under a managed care system only if the benefits for physical illnesses covered under the health benefit plan are delivered under a managed care system.

    A copayment for methadone maintenance treatment cannot be more than 50% of its daily cost. 

    Prohibits plans from applying a preauthorization requirement for drugs used to treat opioid use disorder and that contain methadone, buprenorphine, or naltrexone.

    Plans are required to notify enrollees of the requirements of this section and the Mental Health Parity and Addiction Equity Act of 2008.

     

    Law Citation

  • Massachusetts

    Law Summary

    Massachusetts requires large-employer fully insured plans, small-employer fully insured plans, individual plans, and state employee plans to provide behavioral health treatment coverage on a “non-discriminatory basis” for certain conditions.

    The law explicitly applies to the following conditions and requires that annual limits, lifetime limits, and quantitative treatment limitations for these conditions are the same as they are for other medical conditions: 

    1. Schizophrenia
    2. Schizoaffective disorder
    3. Major depressive disorder
    4. Bipolar disorder
    5. Paranoia and other psychotic disorders
    6. Obsessive-compulsive disorder
    7. Panic disorder
    8. Delirium and dementia
    9. Affective disorders
    10. Eating disorders
    11. Post traumatic stress disorder
    12. Substance abuse disorders
    13. Autism


    Massachusetts also requires individual plans, small-employer fully insured plans, large-employer fully insured plans, and state employee plans to cover the diagnosis and treatment of all other mental disorders not otherwise provided for in this section and which are described in the most recent edition of the DSM during each 12 month period for at least 60 days of inpatient treatment and 24 outpatient visits, as long as the treatment is considered medically necessary. 

    Insurance plans are also required to cover treatment for children under age 19 who do not have any of the conditions listed above who meet these criteria:

    1. They cannot attend school because of their condition
    2. The condition requires hospitalization
    3. Their behavior poses serious danger to themselves or others

    Law Citation

    Section 22. Diagnosis and treatment of certain biologically-based mental disorders; mental disorders of victims of rape; non-biologically-based mental disorders of children and adolescents under age 19; group insurance commission coverage.
    https://malegislature.gov/Laws/GeneralLaws/PartI/TitleIV/Chapter32A/Section22

  • Michigan

    Law Summary

    Michigan state insurance law includes two sections relevant to parity: substance-use disorder coverage and autism coverage. It does not have state laws related to mental health or behavioral health parity.

    Law Citation

  • Minnesota

    Law Summary

    Minnesota insurance law is not a comprehensive parity law because it does not require insurance plans to provide behavioral health coverage; it only applies to plans that do offer behavioral health coverage. 

    Insurance plans cannot place a “greater financial burden” on insured or enrollee for inpatient and outpatient behavioral health services than what is in place for other medical services. 

    Plans also cannot have treatment limitations for inpatient and outpatient behavioral health services that are “more restrictive” than those requirements and limitations for inpatient hospital medical services and outpatient medical services.

    This section also states that all plans must meet the requirements of the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act. 

    Minnesota insurance law defines medically necessary care for mental health treatment and says insurance plans cannot use a more restrictive definition. Medically necessary care means health care services appropriate, in terms of type, frequency, level, setting, and duration, to the enrollee’s diagnosis or condition, and diagnostic testing and preventive services. Medically necessary care must be consistent with generally accepted practice parameters as determined by health care providers in the same or similar general specialty as typically manages the condition, procedure, or treatment at issue and must: 

    1. Help restore or maintain the enrollee’s health;
      OR
    2. Prevent deterioration of the enrollee’s condition

    Law Citation

    62Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL DEPENDENCY SERVICES.
    https://www.revisor.mn.gov/statutes/?id=62Q.47

    62Q.53 MENTAL HEALTH COVERAGE; MEDICALLY NECESSARY CARE.
    https://www.revisor.mn.gov/statutes/?id=62Q.53&format=pdf

  • Mississippi

    Law Summary

    Mississippi requires large-employer fully insured plans to cover services for behavioral health conditions. 

    Individual plans and small-employer fully insured plans must offer optional coverage for behavioral health services. 

    However, this optional coverage must follow the same standards as the mandatory coverage required of large-employer fully insured plans. 

    Mississippi requires coverage for “mental illness,” which it defines as any “psychiatric disease” in the “current edition” of either the ICD or the DSM. 

    Plans are required to cover at least 30 days of inpatient care, 60 days of partial hospitalization, and 52 visits of outpatient care. The “rate of payment” for these services must be the same as for other conditions. 

    Financial requirements, annual maximums, and lifetime maximums for behavioral health services must be “no less favorable” than those in place for other medical services. 

    Law Citation

    § 83-9-37. Definitions.
    § 83-9-39. Coverage.
    § 83-9-41. Mental illness benefits.
    § 83-9-43. Nondiscrimination.

    It is not possible to provide direct links to Mississippi state law. Please follow these instructions to find the appropriate section:

    • Click http://www.lexisnexis.com/hottopics/mscode/ to access the laws of Mississippi
    • Click on the plus sign (+) next to “Title 83. Insurance”
    • Click on the plus sign (+) next to “Chapter 9”
    • Click on the plus sign (+) next to “Coverage for Treatment of Mental Illness”
    • Click on the relevant section
  • Missouri

    Law Summary

    Missouri requires all small-employer fully insured plans, large-employer fully insured plans, and state employee plans to cover all mental health conditions in the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

    The law forbids plans from having any lifetime limits, annual limits, copayments, coinsurance, or outpatient visit limits for mental health services more expensive or restrictive than those for other medical services. 

    The law requires plans to have one deductible or out-of-pocket limit for both mental health services and other medical services. 

    Plans are allowed to use managed care for mental health coverage even if they do not use managed care for other medical coverage. This section also allows plans to use a more involved form of managed care for mental health coverage than what they use for other medical coverage. However, the law states that administrative and clinical procedures should “not serve to reduce access to medically necessary treatment.”

    This section also allows employers to apply for a waiver exempting them from this section of the law if they can show their plan’s compliance with this section caused premiums to increase by at least 2% over any consecutive twenty-four month period.

    Missouri requires individual plans, small-employer fully insured plans, and large-employer fully insured plans to offer optional behavioral health coverage that individuals and employers can accept or reject. 

    Because section 376.1550 requires small-employer fully insured plans and large-employer fully insured plans to cover mental health services, the parts of this section about mental health coverage only apply to individual plans.

    The offered coverage for substance use disorder services must meet the following requirements:

    • 26 visits of outpatient care and partial hospitalization per policy benefit period
    • 21 days of residential treatment per policy benefit period
    • 6 days of detoxification per policy benefit period
    • A lifetime limit of 10 episodes of treatment, with episode defined as “a distinct course of chemical dependency treatment separated by at least thirty days without treatment”
    • Financial requirements that are equal to those used for other medical services 


    The offered coverage for mental health services must meet the following requirements:

    • Outpatient care and partial hospitalization equal to what is in place for other medical conditions 
    • Coinsurance, copayment, deductible, annual maximum, and lifetime maximum equal to other medical services 
    • Residential treatment equal to other medical conditions 
    • Inpatient hospital treatment not to exceed ninety days per year

     

    Law Citation

    §376.1550.1. Mental health coverage, requirements−definitions−exclusions.
    http://www.moga.mo.gov/mostatutes/stathtml/37600015501.html

    §376.811. Coverage required for chemical dependency by all insurance and health service corporations—minimum standards−offer of coverage may be accepted or rejected by policyholders, companies may offer as standard coverage−mental health benefits provided, when--exclusions.
    http://www.moga.mo.gov/mostatutes/stathtml/37600008111.html

  • Montana

    Law Summary

    Montana law defines “severe mental illness” as:

    • Schizophrenia 
    • Schizoaffective disorder
    • Bipolar disorder 
    • Major depression 
    • Panic disorder 
    • Obsessive compulsive disorder 
    • Autism 


    Montana requires large-employer fully insured plans, small-employer fully insured plans, and individual plans to cover services for these conditions "no less favorable" than for the level provided for physical illness generally. 

    This coverage should include, but not be limited to, inpatient benefits, outpatient benefits, emergency care services, and medication.

    This subsection specifically excludes eating disorders besides anorexia and bulimia, developmental disorders, psychoactive substance use disorders, speech disorders, and impulse control disorders besides intermittent explosive disorder and trichotillomania.

    Law Citation

  • Nebraska

    Law Summary

    Nebraska does not require any plans to cover mental health services, but the law has requirements if plans do provide coverage. 

    The law applies to large-employer fully insured plans and small-employer fully insured plans, except for an employer group that covers fewer than fifteen employees.

    The law applies to coverage for serious mental illness, which means “any mental health condition that current medical science affirms is caused by a biological disorder of the brain and that substantially limits the life activities of the person with the serious mental illness.” 

    Serious mental illness includes, but is not limited to: 

    • Schizophrenia 
    • Schizoaffective disorder 
    • Delusional disorder 
    • Bipolar affective disorder 
    • Major depression 
    • Obsessive compulsive disorder 


    If plans cover services for these conditions, they cannot have different annual payment limits or lifetime limits than those in place for other medical services. 

    Limits for outpatient care and inpatient care must be the same as well. 

    If a plan uses a deductible, there must be only one deductible for both mental health services and other medical services. 

    If a plan does not cover mental health services, it must “provide clear and prominent notice of such noncoverage in the plan.”

    Law Citation

    44-791. Mental health conditions; legislative findings.
    http://nebraskalegislature.gov/laws/statutes.php?statute=44-791

    44-792. Mental health conditions; terms, defined.
    http://nebraskalegislature.gov/laws/statutes.php?statute=44-792

    44-793. Mental health conditions; coverage; requirements.
    http://nebraskalegislature.gov/laws/statutes.php?statute=44-793

    44-794. Mental health conditions; sections; how construed.
    http://nebraskalegislature.gov/laws/statutes.php?statute=44-794

    44-795. Mental health conditions; rules and regulations.
    http://nebraskalegislature.gov/laws/statutes.php?statute=44-795

  • Nevada

    Law Summary

    Nevada requires large-employer fully insured plans to comply with the Mental Health Parity and Addiction Equity Act of 2008.

    Nevada requires individual plans and small-employer fully insured plans to cover the following mental health conditions:

    • Schizophrenia 
    • Schizoaffective disorder 
    • Bipolar disorder 
    • Major depressive disorders 
    • Panic disorder 
    • Obsessive-compulsive disorder 


    The law does not specify how plans must cover these conditions.

    Law Citation

    NRS 689A.0455. Coverage for treatment of conditions relating to severe mental illness.
    https://www.leg.state.nv.us/NRS/NRS-689A.html#NRS689ASec0455

    NRS 689C.169. Coverage for severe mental illness. https://www.leg.state.nv.us/NRS/NRS-689C.html#NRS689CSec169

  • New Hampshire

    Law Summary

    Behavioral Health Coverage

    New Hampshire requires individual plans and large-employer fully insured plans to cover behavioral health services.

    For substance use disorder services, plans must cover inpatient care and outpatient care. There must be annual maximums and annual limits, but the law does not clarify their parameters. 

    For mental health services, the state requires small-employer fully insured plans and large-employer fully insured plans to cover inpatient care and residential treatment “at least as favorable” as coverage for inpatient care and residential treatment for other medical services. 

    It also specifies that financial requirements for inpatient care and residential treatment must be substantially the same as the ratio of the benefits as those for other medical services. 

    Plans must cover at least 15 hours in any consecutive 12-month period for outpatient care. 

    For individual plans, deductibles and coinsurance for mental health services must be “at least as favorable” as medical services. 

    There is a $3,000 annual maximum and a $10,000 lifetime maximum per covered individual for mental health services (however, the Affordable Care Act eliminates all lifetime maximums and annual maximums for most plans). 

    This section specifies that this coverage is for inpatient care, outpatient care, and partial hospitalization. 

    This section also authorizes the Commissioner of the New Hampshire Insurance Department to issue regulations regarding the Mental Health Parity and Addiction Equity Act of 2008. 

    Biologically Based Mental Illness

    Section 417-E:1 applies to small-employer fully insured plans and large-employer fully insured plans, and specifies that it takes effect when coverage benefits from the “Behavioral Health Coverage” section (§415:18-a and 420-B:8-b) are exhausted. 

    Coverage for the following conditions must be “under the same terms and conditions and…no less extensive” than coverage for other medical conditions: 

    • Schizophrenia and other psychotic disorders 
    • Schizoaffective disorder 
    • Major depressive disorder 
    • Bipolar disorder
    • Anorexia nervosa and bulimia nervosa  
    • Obsessive-compulsive disorder 
    • Panic disorder
    • Pervasive developmental disorder or autism  
    • Chronic post-traumatic stress disorder 


    Section 417-E:1 also authorizes the Commissioner of the New Hampshire Insurance Department to issue regulations regarding the Mental Health Parity and Addiction Equity Act of 2008. 

    Law Citation

    415:18-a Coverage for Mental or Nervous Conditions and Treatment for Chemical Dependency Required. http://www.gencourt.state.nh.us/rsa/html/XXXVII/415/415-18-a.htm

    417-E:1 Coverage for Certain Biologically-Based Mental Illnesses.
    http://www.gencourt.state.nh.us/rsa/html/XXXVII/417-E/417-E-1.htm

  • New Jersey

    Law Summary

    Many sections of New Jersey's state insurance law relate to mental-health parity. They are summarized below.

    New Jersey insurance law requires individual plans, small-employer fully insured plans, large-employer fully insured plans, and state employee plans to cover services for the following mental health conditions: 

    • Schizophrenia
    • Schizoaffective disorder
    • Major depressive disorder
    • Bipolar disorder
    • Paranoia and other psychotic disorders
    • Obsessive-compulsive disorder
    • Panic disorder
    • Pervasive developmental disorder or autism


    Plans cannot use different copayments, deductibles, and “benefit limits” for these conditions than what are in place for other medical conditions. 

    The various sections specifically state they do not impact how plans make medical necessity determinations for mental health services, and which providers the plans decide to reimburse for mental health services. 

    Law Citation

    17:48-6v Hospital service corporation to provide coverage for biologically-based mental illness.

    17:48A-7u Medical service corporation to provide coverage for biologically-based mental illness.

    17:48E-35.20 Health service corporation to provide coverage for biologically-based mental illness.

    17B:26-2.1s Individual health insurers to provide coverage for biologically-based mental illness.

    17B:27-46.1v Group health insurers to provide coverage for biologically-based mental illness.

    17B:27A-7.5 Individual health benefits plan to provide coverage for biologically-based mental illness.

    17B:27A-19.7 Small employer health benefits plan to provide coverage for biologically-based mental illness.

    26:2J-4.20 HMO to provide coverage for biologically based mental illness.

    52:14-17.29d Definitions relative to biologically-based mental illness.

    52:14-17.29e Biologically-based mental illness terms, conditions, in health benefits contracts.

    To retrieve the sections on the website of the New Jersey Legislature, follow these instructions:

  • New Mexico

    Law Summary

    New Mexico requires large-employer fully insured plans and small-employer fully insured plans to cover mental health services. 

    Plans cannot use treatment limitations or financial requirements for these services unless they use “identical” treatment limitations and financial requirements imposed on coverage of benefits for other conditions. 

    Plans may require prior authorization for inpatient care and outpatient care. They may also restrict their coverage to only medically necessary services.

    The state law also includes two subsections about exemptions for plans if premium costs rise by 1.5% for small-employer fully insured plans and 2.5% for large-employer fully insured plans.

     

    Law Citation

    59A-23E-18. Requirement for mental health benefits in a group health plan, or group health insurance offered in connection with the plan, for a plan year of an employer.

    It is not possible to provide direct links to any sections of the New Mexico statute. To find 59A-23E-18, follow these instructions:

  • New York

    Law Summary

    Timothy’s Law mandates that New York group health plans:

    • Provide broad-based coverage for the diagnosis and treatment of mental disorders at least equal to the coverage provided for other health conditions. 
    • Cover a minimum of 30 days of inpatient care and 20 visits of outpatient care per year for the diagnosis and treatment of mental, nervous or emotional disorders or ailments.
    • Calculate deductibles, co-payments and co-insurance for mental health treatment in a manner consistent with medical/surgical treatment. 
    • Conduct utilization review for mental health benefits in a consistent fashion as for medical/surgical benefits.


    New York law also requires that New York group health plans provide coverage for:

    • At least 60 outpatient visits in any calendar year for the treatment of substance use disorder, of which up to 20 may be for family members. 
    • Inpatient substance use disorder treatment, including detoxification and rehabilitation services. 

    Law Citation

    New York's mental-health parity was enacted by "Timothy's Law."

    It is not possible to link to specific articles and sections of New York’s consolidated laws due to the construction of the website that hosts them. Instead, the New York State Office of Attorney General issued a letter describing state mental health parity at
    http://www.ag.ny.gov/sites/default/files/pdfs/publications/Mental-Health-Parity-Flyer-for-providers.pdf

  • North Carolina

    Law Summary

    North Carolina requires large-employer fully insured plans and small-employer fully insured plans to use financial requirements, annual maximums, and lifetime maximums for mental health services that are "no less favorable" than benefits for physical illness generally, including application of the same limits. 

    However, if plans use many different forms of these for varying physical health services, the insurer may impose limits on the benefits provided, using a weighted average calculation in accordance with rules adopted by the Commissioner of the North Carolina Department of Insurance. 

    See http://reports.oah.state.nc.us/ncac/title%2011%20-%20insurance/chapter%2012%20-%20life%20and%20health%20division/11%20ncac%2012%20.0563.pdf for information about the mathematical formula.

    For treatment of the following conditions, annual limits have to be the same as those used for treatment of physical illnesses generally:

    • Bipolar Disorder
    • Major Depressive Disorder 
    • Obsessive Compulsive Disorder 
    • Paranoid and Other Psychotic Disorder 
    • Schizoaffective Disorder 
    • Schizophrenia 
    • Post-Traumatic Stress Disorder 
    • Anorexia Nervosa 
    • Bulimia 


    For all other mental health conditions in the Diagnostic and Statistical Manual of Mental Disorders (DSM) (except for substance use disorders), plans must cover 30 office visits for outpatient care and 30 days of inpatient care, or a combination of inpatient care and outpatient care that could be measured in days (ie, partial hospitalization). 

    North Carolina also requires large-employer fully insured plans to comply with the Mental Health Parity and Addiction Equity Act of 2008. 

    Law Citation

  • North Dakota

    Law Summary

    North Dakota requires large-employer fully insured plans and small-employer fully insured plans to cover mental health services. 

    This section requires plans to cover the following each year:

    • A minimum of forty-five days of inpatient care
    • A minimum of thirty hours for outpatient care
    • No deductibles or copayments for the first 5 hours of outpatient care in any calendar year (a deductible is specifically allowed in the first 5 hours for high-deductible plans) 
    • Coinsurance after the first 5 hours of outpatient care cannot be greater than 20% 
    • A minimum of one hundred twenty days of services for partial hospitalization
    • A minimum of one hundred twenty days of services covered for residential treatment (patients can exchange up to 23 days of inpatient treatment benefits for 46 additional days of residential treatment) 

    Law Citation

    26.1-36-09. Group health policy and health service contract mental disorder coverage.
    http://www.legis.nd.gov/cencode/t26-1c36.pdf?20150611143634

  • Ohio

    Law Summary

    Ohio requires individual plans, small-employer fully insured plans, large-employer fully insured plans, and self-insured plans (not exempted from state jurisdiction by ERISA) to cover services for the following mental health conditions (as defined in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders [DSM]): 

    • Schizophrenia 
    • Schizoaffective disorder
    • Major depressive disorder 
    • Bipolar disorder 
    • Paranoia and other psychotic disorders 
    • Obsessive-compulsive disorder 
    • Panic disorder 



    Coverage for these biologically based conditions must be “on the same terms and conditions” and “no less extensive” than "those provided under the plan of health coverage for the treatment and diagnosis of all other physical diseases and disorders" if the following two conditions are met:

    1) The mental illness must be biologically based and clinically diagnosed.

    2) The prescribed treatment is not experimental or investigational, having proven its clinical effectiveness in accordance with generally accepted medical standards.

    Ohio’s Revised Code states this applies specifically (but not only) to inpatient care, outpatient care, medication, deductibles, copayments, lifetime limits, and lifetime maximums. 

    Plans are allowed to use non-quantitative treatment limitations (NQTLs). 

    Plans are allowed to file for an exemption from this section of the law if they can prove complying with this section of the law for 6 months caused cost increases of at least 1%. 

    For any other mental health condition not listed above, Ohio requires plans to offer optional coverage that includes a $550 annual maximum for outpatient care and nothing else.

    Law Citation

    3923.281 Sickness and accident policies - biologically based mental illness.
    http://codes.ohio.gov/orc/3923.281

    3923.282 Health coverage plans - biologically based mental illness.
    http://codes.ohio.gov/orc/3923.282

  • Oklahoma

    Law Summary

    Oklahoma requires large-employer fully insured plans to cover services for the following conditions designated as “severe mental illness”: 

    • Schizophrenia 
    • Bipolar disorder (manic-depressive illness)
    • Major depressive disorder 
    • Panic disorder
    • Obsessive-compulsive disorder 
    • Schizoaffective disorder 


    Oklahoma does not require plans to cover services for other mental health conditions and substance use disorders but, if they do, the coverage must be the same as required for “severe mental illness.”

    Coverage for severe mental illness, and any other covered behavioral health conditions, must “be equal to” and “no more restrictive” than other medical services for the following:

    • Prior authorization
    • Utilization review 
    • Outpatient care 
    • Medication coverage 
    • Lifetime maximums 
    • Copayments and coinsurance 
    • Deductibles 
    • Home visit coverage 
    • Any other treatment limitations  


    Plans cannot use any treatment limitation for behavioral health services not in place for other medical services. 

    Plans must cover either 26 days of inpatient care or the same inpatient day limit used for other medical care, whichever is greater. 

    Plans can file for an exemption if they can demonstrate coverage of “severe mental illness” caused premiums to rise at least 2% over the course of a year. 

    Law Citation

  • Oregon

    Law Summary

    Oregon insurance law requires large-employer fully insured plans and small-employer fully insured plans to cover behavioral health services “at the same level” and with treatment limitations “no more restrictive” than other medical services. 

    Deductibles and coinsurance for inpatient care, outpatient care, and residential treatment cannot be greater than what are used for other medical services. 

    Annual maximums, annual limits, lifetime maximums, and lifetime limits must be similar to those used for other medical services. 

    Plans are not required to cover more than 45 consecutive days of residential treatment. 

    Plans are allowed to use utilization review, prior authorization, and other non-quantitative treatment limitations (NQTLs). 

    Plans are not required to apply NQTLs to how they are used with other medical care. 

    However, utilization review must be conducted according to the standards of National Committee for Quality Assurance or Medicare review standards of the Centers for Medicare and Medicaid Services. 

    Plans are required to cover out-of-network providers for behavioral health services, even if there are in-network providers that provide those services. 

    Law Citation

    743A.168 Treatment of chemical dependency, including alcoholism, and mental or nervous conditions; qualified providers; rules.
    https://www.oregonlegislature.gov/bills_laws/ors/ors743A.html

  • Pennsylvania

    Law Summary

    Pennsylvania’s parity provisions apply to people with “serious mental illness” (SMI), defined as: 

    1. Schizophrenia
    2. Bipolar disorder
    3. Obsessive-compulsive disorder
    4. Major depressive disorder
    5. Panic disorder
    6. Anorexia nervosa
    7. Bulimia nervosa
    8. Schizoaffective disorder
    9. Delusional disorder


    For people with SMI, plans are required to cover at least 30 days of inpatient care and 60 outpatient visits per year. 

    A person covered under such policies shall be able to convert coverage of inpatient days to outpatient days on a one-for-two basis.

    The law does specify that there cannot be any annual maximum or lifetime maximum in coverage that are different than limits for other medical care. 

    Law Citation

    Section 635.1. Mental Illness Coverage.
    http://www.legis.state.pa.us/WU01/LI/LI/US/PDF/1921/0/0284..PDF

  • Rhode Island

    Law Summary

    Behavioral Health Coverage

    Rhode Island requires large-employer fully insured plans, small-employer fully insured plans, and individual plans to cover services for all behavioral health conditions in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) under the “same terms and conditions” as those provided for other illnesses and diseases. 

    Financial requirements and quantitative treatment limitations for behavioral health services must be “no more restrictive” than the predominant financial requirements applied to substantially all coverage for medical conditions in each treatment classification.

    If plans use non-quantitative treatment limitations for behavioral health services, they must be used similarly and “no more stringently” than the processes, strategies, evidentiary standards, or other factors used in applying the limitations for other medical services.

    Non-quantitative treatment limitations are defined as: 

    • Medical management standards
    • Formulary design and protocols
    • Network tier design
    • Standards for provider admission to participate in a network
    • Reimbursement rates and methods for determining usual, customary, and reasonable charges
    • Other criteria that limit scope or duration of coverage for services in the treatment of mental health and substance use disorders, including restrictions based on geographic location, facility type, and provider specialty


    Rhode Island requires plans to cover medications for substance use disorders, specifically those used for opioid overdoses (like naloxone) and those used for chronic addiction (like methadone). 

    When conducting medical necessity reviews for behavioral health services, plans must do so the same as medical necessity reviews are conducted for other medical services. 

    Utilization Review

    Rhode Island requires the Department of Health to develop reporting requirements for insurance plans’ utilization review programs for compliance with the Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act. 

    The state also requires the Department of Health to make recommendations to the General Assembly as to how state laws and regulations could be changed to improve parity compliance for utilization review programs, or make these regulatory changes itself. 

    Included among these recommendations or changes, this section of the law requires the Department of Health to describe the process by which the Department will investigate insurance plans for parity compliance in their utilization review programs. 

    Law Citation

    § 27-38.2. Insurance Coverage for Mental Illness and Substance Abuse.
    http://webserver.rilin.state.ri.us/Statutes/TITLE27/27-38.2/INDEX.HTM

    § 23-17.12-12 Reporting requirements.
    http://webserver.rilin.state.ri.us/Statutes/TITLE23/23-17.12/23-17.12-12.HTM

  • South Carolina

    Law Summary

    Large-employer Plans

    South Carolina requires large-employer fully insured plans to cover the following mental health conditions:

    • Bipolar Disorder 
    • Major Depressive Disorder
    • Obsessive Compulsive Disorder  
    • Paranoid and Other Psychotic Disorders
    • Schizoaffective Disorder
    • Schizophrenia 
    • Anxiety Disorder 
    • Post-traumatic Stress Disorder  
    • Depression in childhood and adolescence 


    For these conditions, plans cannot have any financial requirements more expensive than those in place for treatment of other medical conditions. 

    Deductibles and other out-of-pocket annual maximums or lifetime maximums for these conditions must be part of the same deductibles or out-of-pocket maximums in place for all other medical services. 

    For all other covered behavioral health conditions, plans cannot use annual maximums and lifetime maximums for behavioral health services or have annual limits and lifetime limits if not in place for other medical services. 

    If a plan does have these in place for other medical services, they can do either of the following: 

    • Have both behavioral health services and other medical services count towards combined limits and maximums 
      OR
    • Have the limits and maximums for behavioral health services no less than the ones in place for other medical services 


    For plans that have many different limits and maximums for different categories of medical care, the law requires the Director of the South Carolina Department of Insurance to use a mathematical formula to decide what the limits and maximums should be for behavioral health services. 

    Plans must ensure that financial requirements and treatment limitations for all behavioral health conditions are “no more restrictive” than those used for treatment of other medical conditions. 

    Plans can file for an exemption if their costs increase by 2% in the first year of providing this coverage or if costs increase by 1% in any other year. 

    Small-employer Plans

    Small-employer fully insured plans and exempted large-employer fully insured plans must offer optional behavioral health coverage to employers. 

    These plans can use different deductibles and coinsurance for behavioral health services than those used for other medical services.

    The plans must have an annual maximum of $2,000 and a lifetime maximum of $10,000 for behavioral health services.

    Law Citation

    SECTION 38-71-290. Mental health coverage; definitions; treatment requirements; exceptions.

    SECTION 38-71-880. Medical and surgical benefits and mental health or substance use disorder benefits; aggregate lifetime limits. 

    SECTION 38-71-737. Requirement of coverage for psychiatric conditions in group health insurance policies; "psychiatric conditions" defined.

    Sections -290, -880, and -737 available at: 
    http://www.scstatehouse.gov/code/t38c071.php

  • South Dakota

    Law Summary

    South Dakota requires individual plans, small-employer fully insured plans, and large-employer fully insured plans to cover services for the following conditions:

    • Schizophrenia and other psychotic disorders 
    • Bipolar disorder 
    • Major depression 
    • Obsessive-compulsive disorder 


    This coverage must have the same annual maximums, lifetime maximums, deductibles, coinsurance, and restrictions as other medical services.

    Law Citation

    58-17-98. Health insurance policies to provide coverage for biologically-based mental illnesses.
    http://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&Statute=58-17-98

  • Tennessee

    Law Summary

    Large-employer Fully Insured Plans

    Tennessee requires large-employer fully insured plans to determine annual maximums and lifetime maximums for mental health benefits similarly to other medical benefits.

    The state exempts small-employer plans and individual plans from this requirement.

    Tennessee requires 20 days of inpatient mental healthcare and 25 outpatient visits. 

    The state also allows inpatient days to be used instead for residential care or partial hospitalization, with the day limit doubled, allowing a person up to 40 days of coverage. 

    Office visits for medication management do not count as outpatient visits. 

    Small-employer Fully Insured Plans and Individual Plans

    Insurance companies must offer small-employer fully insured plans and individual plans these benefits for behavioral health coverage:

    • 30 visits for outpatient care
    • Deductibles and coinsurance equal to other medical services
    • Residential treatment (no day limit listed)


    The small-employers or individuals can choose different plans that do not meet these requirements.

    Law Citation

    56-7-2360. Coverage for mental health services.

    It is not possible to provide direct links to any section of Tennessee law. To find this section, follow these instructions:


    56-7-2601. Health insurance – Coverage of mental illness.

    It is not possible to provide direct links to any section of Tennessee law. To find this section, follow these instructions:

  • Texas

    Law Summary

    This section of the law applies to large-employer fully insured plans, small-employer fully insured plans, and local government plans. 

    However, the coverage described below is optional for small-employer fully insured plans. 

    This section only applies coverage to the following conditions, defined in this section as “serious mental illness”: 

    1. Bipolar disorders (hypomanic, manic, depressive, and mixed) 
    2. Depression in childhood and adolescence 
    3. Major depressive disorders (single episode or recurrent) 
    4. Obsessive-compulsive disorders 
    5. Paranoid and other psychotic disorders 
    6. Schizo-affective disorders (bipolar or depressive) 
    7. Schizophrenia 


    Texas law requires plans to provide at least 45 days of inpatient treatment and 60 visits for outpatient treatment, including group and individual outpatient treatment, and states that plans “must include the same limitations, deductibles, copayments, and coinsurance factors for serious mental illness as the plan includes for physical illness.” 

    Plans “must provide coverage for an outpatient visit under the same terms as the coverage the issuer provides for an outpatient visit for the treatment of physical illness.”

    Texas forbids any lifetime limitations within a plan for inpatient days and outpatient visits.

    The law specifies that plans offering coverage in a hospital for a child or adolescent with a “mental or emotional illness or disorder” must provide coverage for the child in a “residential treatment center for children and adolescents or a crisis stabilization unit that is at least as favorable as the coverage the plan provides for treatment of mental or emotional illness or disorder in a hospital.” 

    The state also specifies that each two days of treatment in a residential treatment center or crisis stabilization unit are equivalent to one day of coverage for treatment in a hospital. 

    Texas law also has language addressing partial hospitalization. 

    It specifies that plans offering inpatient coverage must also provide coverage for “psychiatric day treatment.” 

    Each day of coverage for psychiatric day treatment is equivalent to one-half day of coverage for inpatient or hospital care. 

    Plans may use managed care. 

    Also, local governments may not provide coverage for serious mental illness that is “less extensive than the coverage provided for any other physical illness.” 

     

    Law Citation

    CHAPTER 1355. BENEFITS FOR CERTAIN MENTAL DISORDERS.
    http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1355.htm

  • Utah

    Law Summary

    Utah requires large-employer fully insured plans to offer optional behavioral health coverage that complies with the Mental Health Parity and Addiction Equity Act of 2008. 

    Individual plans must cover behavioral health services that comply with the Mental Health Parity and Addiction Equity Act of 2008. 

    Law Citation

    31A-22-625. Catastrophic coverage of mental health conditions. http://le.utah.gov/xcode/Title31A/Chapter22/31A-22-S625.html?v=C31A-22-S625_2014040320140513

  • Vermont

    Law Summary

    Vermont requires individual plans, small-employer fully insured plans, large-employer fully insured plans, and any state administered insurance plans to cover all behavioral health conditions listed in the International Classification of Diseases (ICD). 

    Plans cannot use any financial requirement or quantitative treatment limitation for behavioral health services that “places a greater burden on an insured” for access to care than other medical services. 

    Plans cannot exclude any provider from in-network status if the provider is willing to meet the terms and conditions of being in the network. 

    There must be only one deductible for all medical care, including behavioral healthcare and other medical care. 

    Plans can use managed care (and separate managed care organizations) for behavioral health services, even if they do not for other medical services, but the managed care practices must follow regulations issued by the Commissioner of the Department of Financial Regulation. 

    Those regulations must ensure that: 

    • Timely and appropriate access to care is available
    • The quantity, location, and specialty distribution of health care providers is adequate
    • Administrative or clinical protocols do not serve to reduce access to medically necessary treatment for any insured
    • Utilization review and other administrative and clinical protocols do not deter timely and appropriate care, including emergency hospital admissions
    • In the case of a managed care organization which contracts with a health insurer to administer the insurer's mental health benefits, the portion of a health insurer's premium rate attributable to the coverage of mental health benefits is reviewed under section 4062, 4513, 4584, or 5104 of this title to determine whether it is excessive, inadequate, unfairly discriminatory, unjust, unfair, inequitable, misleading, or contrary to Vermont laws
    • The health insurance plan is consistent with the Blueprint for Health with respect to mental conditions, as determined by the Commissioner under 18 V.S.A. § 9414(b)(2)
    • A quality improvement project is completed annually as a joint project between the health insurance plan and its mental health managed care organization to implement policies and incentives to increase collaboration among providers that will facilitate clinical integration of services for medical and mental conditions, including:
      • evidence of how data collected from the quality improvement project are being used to inform the practices, policies, and future direction of care management programs for mental conditions
      • demonstration of how the quality improvement project is supporting the incorporation of best practices and evidence-based guidelines into the utilization review of mental conditions
    • An up-to-date list of active mental health care providers in the plan's network who are available to the general membership is available on the health insurer's and managed care organization's websites and provided to consumers upon request
    • The health insurers and managed care organizations make accessible to consumers the toll-free telephone number for the Vermont Health Care Administration's consumer protection help line

    Law Citation

    § 4089b. Health insurance coverage, mental health, and substance abuse.
    http://legislature.vermont.gov/statutes/section/08/107/04089b

  • Virginia

    Law Summary

    Behavioral Health Coverage 

    Virginia requires large-employer fully insured plans, individual plans, and non-grandfathered small-employer fully insured plans to cover behavioral health services that meet the standards of the Mental Health Parity and Addiction Equity Act of 2008. 

    Virginia requires the following for grandfathered small-employer fully insured plans: 

    • 20 days of inpatient care for adults 
    • 25 days of inpatient care for children and adolescents
    • Up to 10 days of inpatient care can be turned into 15 days of partial hospitalization (1 for 1.5 ratio) 
    • 20 visits for outpatient care 
    • Medication management visits do not count towards outpatient visit limit 
    • For any coinsurance, a plan must cover at least 50% for the first 5 outpatient visits 
    • Any outpatient visit not covered because the person has not yet met the plan-deductible does not count towards the 20-visit limit 


    State Employee Plan Behavioral Health Coverage

    Virginia requires state-employee plans to cover “biologically based mental illness” and have the same coinsurance, copayments, annual maximums, lifetime maximums, annual limits, and lifetime limits as other medical treatment.

    Medical necessity reviews for “biologically-based mental illness” must be conducted “in the same manner” as those for other medical treatment. 

    “Biologically-based mental illness” is defined as: 

    • Schizophrenia
    • Schizoaffective disorder
    • Bipolar disorder
    • Major depressive disorder
    • Panic disorder
    • Obsessive-compulsive disorder
    • Attention deficit hyperactivity disorder
    • Autism
    • Drug and alcoholism addiction

    Law Citation

    §38.2-3412.1. Coverage for mental health and substance use disorders.
    http://law.lis.virginia.gov/vacode/title38.2/chapter34/section38.2-3412.1/

    § 2.2-2818. Health and related insurance for state employees.
    http://law.lis.virginia.gov/vacode/2.2-2818/

  • Washington

    Law Summary

    Washington State's Mental Health Parity Act requires all health plans that include medical and surgical services to also cover mental health services. 

    Also, any copayments, cost-sharing and prescription drug coverage limits must apply to all services, including mental health. 

    Law Citation

    RCW 48.20.580 - Mental health services—Definition—Coverage required, when.
    http://apps.leg.wa.gov/RCW/default.aspx?cite=48.20.580

    RCW 48.21.241 - Mental health services—Group health plans—Definition—Coverage required, when.
    http://apps.leg.wa.gov/rcw/default.aspx?cite=48.21.241

  • West Virginia

    Law Summary

    Behavioral Health Coverage for Group Plans

    West Virginia requires large-employer fully insured plans and small-employer fully insured plans to cover services for the following behavioral health conditions: 

    • Schizophrenia and other psychotic disorders
    • Bipolar disorders
    • Depressive disorders
    • Substance-related disorders, with the exception of caffeine-related disorders and nicotine-related disorders
    • Anxiety disorders
    • Anorexia
    • Bulimia


    Quantitative treatment limitations, financial requirements, and non-quantitative treatment limitations must be applied similarly for behavioral health services and other medical services. 

    Plans may use “whatever additional cost containment measures may be necessary,” including, but not limited to, limitations on inpatient and outpatient benefits, if they can prove complying with this section of the law increases total costs by at least 2%. 

    Plans are exempted from covering custodial care, residential care or schooling.

    Behavioral Health Coverage for State Employee Plans

    West Virginia requires state employee plans to cover services for the following behavioral health conditions:

    • Schizophrenia and other psychotic disorders
    • Bipolar disorders
    • Depressive disorders
    • Substance use disorders
    • Anxiety disorders
    • Anorexia
    • Bulimia
    • Attention deficit hyperactivity disorder through age 18
    • Separation anxiety disorder through age 18
    • Conduct disorder through age 18


    Non-quantitative treatment limitations must be applied similarly for behavioral health services and other medical services. 

    Plans may use “whatever cost containment measures may be necessary,” including day and visit limits on inpatient care and outpatient care if they can prove complying with this section of the law causes total costs to increase by at least 2%. 

    Plans are exempted from covering custodial care, residential care or schooling.

    Mental Health Coverage for Individual Plans

    West Virginia requires individual plans to offer optional coverage for any mental health condition that meets the following requirements: 

    • 45 consecutive days, in any calendar year, of inpatient care in a mental hospital
    • Inpatient benefits, when confined in a licensed or accredited general hospital, shall be no different than for any other illness
    • 50% of eligible expenses for outpatient benefits up to $500 over a twelve-month period

    Law Citation

    §33-16-3a. Same − Mental health.
    http://www.legis.state.wv.us/WVCODe/ChapterEntire.cfm?chap=33&art=16&section=3a

    §5-16-7. Authorization to establish group hospital and surgical insurance plan, group major medical insurance plan, group prescription drug plan and group life and accidental death insurance plan; rules for administration of plans; mandated benefits; what plans may provide; optional plans; separate rating for claims experience purposes.
    http://www.legis.state.wv.us/WVCODE/ChapterEntire.cfm?chap=05&art=16&section=7#16#16

    §33-15-4a. Required policy provisions − Mental illness.
    http://www.legis.state.wv.us/WVCODe/ChapterEntire.cfm?chap=33&art=15&section=4a

  • Wisconsin

    Law Summary

    Wisconsin requires small-employer fully insured plans with more than 10 employees, large-employer fully insured plans, and self-insured state, county, city, village, and school district plans to cover behavioral health services for inpatient care, outpatient care, and intermediate levels of care if they provide services in these categories for other medical treatment.

    Financial requirements, annual maximums, lifetime maximums, outpatient visit limits, out-of-pocket limits, and durational limits (like inpatient day limits) for behavioral health services cannot be “more restrictive” than other medical services.

    Plans are also required to have only one deductible that includes behavioral health treatment. 

    Individual plans must also abide by this if they cover behavioral health services.

    Plans can be exempted from this section of the law if they can demonstrate their overall costs increased by 2% in the first year of complying with this section, or if costs increase by 1% in any subsequent year. 

    Plans are required, upon request, to disclose to enrollees and their providers the criteria for making medical necessity determinations. 

    Plans are also required, upon request, to disclose to enrollees the reasons for any denials or restrictions of treatment. 

     

    Law Citation

    632.89 Coverage of mental disorders, alcoholism, and other diseases.
    http://docs.legis.wisconsin.gov/statutes/statutes/632/VI/89

  • Wyoming

    Law Summary

    Wyoming does not have any parity-related sections of its state insurance law.

    Law Citation