Know Your Plan

Individuals who have a fully insured plan offered by a large employer (51 or more employees) have the most parity protections in law. These plans are covered by both the Federal Parity Law and Maryland’s Parity Law (1993) and must meet the requirements of both laws. These plans MUST provide mental health and addiction benefits, and they must be equal to medical and surgical benefits.

Federal Parity Law requires:

Any Mental Health/Addiction Benefits offered must be equal to medical/surgical benefits in 6 categories:

1. In-network, inpatient
2. In-network, outpatient
3. Out-of-network, inpatient
4. Out-of-network, outpatient
5. Emergency services
6. Prescription drugs

Maryland Parity Law requires that plan benefits include:

• At least the same number of days for mental health and addiction inpatient care is covered under the plan for medical/surgical inpatient care
• At least 60 days for partial hospitalization
• Coverage for outpatient mental health/addiction visits must be equal to medical/surgical visit coverage, including diagnostic testing

Both Federal and Maryland Parity Laws require that plan benefits include:

• No discrimination in cost-sharing.
• No separate deductible, lifetime limit or annual out-of-pocket limits

Complaints Should be Filed With: Maryland Insurance Administration and/or US Department of Labor.

Learn More about your Rights under these laws.
Take Action and file a complaint or Contact Us to get help.

The different state and federal rules governing mental health coverage make understanding the insurance system difficult. Some plans are covered by federal law, some by state law, and some by neither. Understanding your plan coverage is vital to understanding your rights and being able to take appropriate action if you believe your rights have been violated.