Parity

Parity of Mental Health and Substance Use Benefits with Other Benefits: Using Your Employer-Sponsored Health Plan to Cover Services

If you are someone who is trying to figure out how to use your health coverage provided by your employer to pay for your mental health or substance use services – this sheet is for you.

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Mental Health Parity for Public Employees

It took over a decade and spanned the terms of three Governors, but Friday, September 20th the fight for full mental health parity for members of the State Health Benefit and School Employee Health Benefit Plans was won.

On Friday morning the State Health Benefit Plan Design Committee voted for a policy change that will bring full mental health parity to the plan’s 900,000 plus members. The School Employee Plan Design Committee had earlier voted for the same change.

Full mental health parity has been the law of the land and already applies to all private sector and nearly all public sector health plans as well as Medicare and Medicaid. The state plans, through an obscure provision available only to self-funded state and local government plans had been able to avoid enforcement of the federal mental health parity act of 2008 by seeking an annual waiver.

Since the Plan Design Committees have now changed the design of the health plans to end all restriction on mental health benefits, the State Health Benefit Commission will no longer have the authority to seek a waiver from the federal Mental Health Parity Act.

While previous changes required by the Affordable Care Act had ended the very restrictive annual and lifetime maximum spending limits on mental health services, Friday’s action means that visit and day limits will no longer be applied to services for so-called “non-biologically based mental illnesses” such as eating disorders and post traumatic stress disorder. Additionally, co-pays and deductibles for treatment services for all mental disorders must now be the same as for treatment of other disorders.

The union members of State Health Benefit Plan Design Committee had previously voted twice for mental health parity; today they were finally joined by the Christie administration members.

The steadfast and effective support of the mental health community was essential to the union effort to achieve mental health parity in the state plans. Phil Lubitz of the National Alliance on Mental Illness-NJ and Lynn Grefe of the National Association of Eating Disorders played key roles in the effort. Also adding invaluable support were the National Association of Social Workers-NJ, the New Jersey Association of Mental Health and Addiction Agencies, the New Jersey Medical Association, the New Jersey Psychological Association, and the NCADD.