The Department of Labor (DOL) Employee Benefits Security Administration (EBSA) released the Fiscal Year (FY) 2020 Mental Health Parity and Addiction Equity Act (MHPAEA) fact sheet
EBSA investigated and closed 180 health plan investigations in FY 2020. Fifty-six of these investigations involved fully insured plans, 103 involved self-insured plans, and 21 involved plans of both types (the plan or service provider offered both fully insured and self-insured options).
Agencies investigated MHPAEA violations in the following categories:
- (1) Annual dollar limits: dollar limitations on the total amount of specified benefits that may be paid in a
12-month period under a group health plan or health insurance coverage for any coverage unit (such as
self-only or family coverage).
- (2) Aggregate lifetime dollar limits: dollar limitations on the total amount of specified benefits that may be
paid under a group health plan or health insurance coverage for any coverage unit.
- (3) Benefits in all classifications: requirement that if a plan or issuer provides mental health or substance
use disorder benefits in any classification described in the MHPAEA final regulations, mental health or
substance use disorder benefits must be provided in every classification in which medical/surgical
benefits are provided.5
- (4) Financial requirements: deductibles, copayments, coinsurance, or out-of-pocket maximums.
- (5) Treatment limitations: limits on benefits based on the frequency of treatment, number of visits, days of
coverage, days in a waiting period, or other similar limits on the scope or duration of treatment.
Treatment limitations include both quantitative treatment limitations (QTLs), which are expressed
numerically, and nonquantitative treatment limitations (NQTLs), which otherwise limit the scope or
duration of benefits for treatment under a plan or coverage.
- (6) Cumulative financial requirements and QTLs: financial requirements and treatment limitations that
determine whether or to what extent benefits are provided based on certain accumulated amounts.
They include deductibles, out-of-pocket maximums, and annual or lifetime day or visit limits.
In addition, EBSA investigated other ERISA violations (such as claims processing and disclosure violations)
affecting mental health and substance use disorder benefits.