Glen Mulready: Understanding mental health parity and your insurance coverage

Often, when we discuss health insurance, we focus mainly on physical health benefits for operations, hospital visits or medication and don't mention another important component of well-being: mental health.

More than one in five U.S. adults live with a mental illness, according to the Centers for Disease Control and Prevention.

Around the same percentage of Oklahomans (almost 790,000 people) experience a mental illness every year.

This is a topic I hope enters the conversation more, and I want Oklahomans to understand mental health parity and insurance coverage.

What is parity?

First, it's crucial to understand what parity is. In this case, mental health parity means mental health coverage under an insurance plan is equal to physical health coverage.

Mental health hasn't always been treated the same as physical health coverage, with this issue addressed by multiple laws over the decades.

In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.

In Oklahoma, we passed SB1718 in 2020, which requires carriers in the state to offer mental health and substance use disorder coverage in parity.

Is my plan included under mental health parity?

All fully insured health plans sold to individuals, small employer groups and large employer groups must include benefits for mental health and substance use disorder services.

Self-funded health plans (commonly provided by large employers) aren't required to cover these services. If they do include this coverage, it must be provided in parity with benefits for physical illness.

In general, parity rules apply to:

Private-sector employment-sponsored group health plans with 51 or more workers

Private plans of smaller employers that started offering health insurance benefits or made major changes to their health insurance plans after March 23, 2010

Plans sponsored by non-federal governmental employers with 51 or more workers (although self-insured non-federal governmental plans can opt out if they follow certain procedures)

Most health insurance coverage sold to individuals, including coverage sold through the Health Insurance Marketplace

Most, but not all, Medicaid managed care programs and all Children's Health Insurance Program (CHIP) programs

However, parity does not apply to Medicare fee-for-service or Medicare Advantage plans.

What if my health insurance plan doesn't treat mental health and physical health equally?

Review your health insurance plan and look closely at your benefits. If you determine your insurer does not meet parity but does meet the above criteria, contact us at the Oklahoma Insurance Department at 800-522-0071 or visit oid.ok.gov.

We can help review policies and contact insurance companies on your behalf to ensure compliance with state and federal parity laws. For immediate mental health assistance, call or text Oklahoma's Mental Health Lifeline at 988.

Glen Mulready is a former state legislator who has served as Oklahoma's Insurance Commissioner since 2019. He was elected to the post in 2018.