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The Mental Health Parity and Addiction Equity Act ( MHPAEA ) __________________________________________________________
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 ( MHPAEA ) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder ( MH / SUD ) benefits from imposing less favorable benefit limitations on those benefits than on medical / surgical benefits .
MHPAEA originally applied to group health plans and group health insurance coverage and was amended by the Patient Protection and Affordable Care Act , as amended by the Health Care and Education Reconciliation Act of 2010 ( collectively referred to as the “ Affordable Care Act ”) to also apply to individual health insurance coverage . HHS has jurisdiction over public sector group health plans ( referred to as “ non-Federal governmental plans ”), while the Departments of Labor and the Treasury have jurisdiction over private group health plans .
Employment-related group health plans may be either “ insured ” ( purchasing insurance from an issuer in the group market ) or “ self-funded .” The insurance that is purchased , whether by an insured group health plan or in the individual market , is regulated by the State ’ s insurance department . Group health plans that pay for coverage directly , without purchasing health insurance from an issuer , are called self-funded group health plans . Private employment-based group health plans are regulated by the Department of Labor . Non-Federal governmental plans are regulated by HHS . Contact your employer ’ s plan administrator to find out if your group coverage is insured or self-funded and to determine what entity or entities regulate your benefits .
MHPAEA does not apply directly to small group health plans , although its requirements are applied indirectly in connection with the Affordable Care Act ’ s essential health benefit ( EHB ) requirements as noted below . The Protecting Affordable Coverage for Employees Act amended the definition of small employer in section 1304 ( b ) of the Affordable Care Act and section 2791 ( e ) of the Public Health Service Act to mean generally an employer with 1-50 employees , with the option for states to expand the definition of small employer to 1-100 employees . The Employee Retirement and Income Security Act and the Internal Revenue Code also define a small employer as one that has 50 or fewer employees . ( Some states may have mental health parity requirements that are stricter than federal