MHPA Question

[Brian Haynes]

As we all know, the Mental Health Parity Act requires that group health plans, insurance companies and HMOs offering mental heatlh benefits may not set annual or lifetime dollar limits that are lower than any such dollar limits for medical and surgical benefits. However, a plan may limit the number of visits covered or the number of days of coverage. The DOL has taken the position in an audit of an employer's health plan that the plan cannot impose constructive dollar limits on mental health coverage through a combined limit on the number of visits allowed with a fixed dollar reimbursement cap per visit. I believe this is consistent with the position taken by the DOL on its website. It is my understanding that the New York State Insurance Department reads MHPA to only prevent stated annual or lifetime dollar limits and that a per-visit dollar maximum coupled with a limit on the number of allowed visists is permissible. Has anyone had to deal with the DOL on this issue and if so, what was the result? Thanks for your input.

[Guest chloe]

Our position, as an administrator, has always been that a combined day/visit and dollar maximum would not be permitted because it equates to an annual dollar maximum. The plan would be limiting the amount of dollars it would pay in a year. We did have a few customers disagree with us and they added the dollar limits on top of the day/visit limits. At least one (if not more) were found in non-compliance during a DOL audit. They had to change their plan.