The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that benefits for mental health and substance use disorders (MH/SUD) be provided and administered in a fashion that is no more restrictive than the manner in which medical/surgical benefits are provided.
The Final Rules for MHPAEA were released on November 13, 2013 and apply to most plans as they renew on or after July 1, 2014.
For more information on MHPAEA:
Your medical plan and Optum have worked together to comply with Federal Mental Health Parity. You have access to your plan documents (e.g., your Certificate of Coverage or Summary Plan Description) as well as the medical necessity and coverage determination guidelines for both medical/surgical and mental health/substance use disorder benefits. You also have access to detailed information regarding Optum’s Guidelines/Policies & Manuals related to mental health/substance use disorder benefits.
The following is a typical summary of the processes, strategies, evidentiary standards, and other factors that may be used to apply benefit plan terms and conditions (also known as non-quantitative treatment limitations) with respect to mental health/substance use disorder benefits. However, the mental health/substance use disorder non-quantitative treatment limitations will vary based on the specific requirements of your medical/surgical plan.
A comparable summary for your medical benefits may be available to you from your medical plan.