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Aspects of Healthcare Reform: The Individual Market; Mental Health and Substance Abuse Parity
Timothy Jost, in Health Affairs Forefront Link to more items from this source
[Guidance Overview]
Nov. 10, 2013

"[It] seems that insurers have set their rates based on projections that the 2014 risk pool is going to be pretty expensive, and that state regulators have allowed them to do so.... [T]he proposed solutions may simply make matters worse... The basic rule is that where plans or issuers offer mental health or substance use disorder benefits in one of six classifications, they cannot impose financial requirements or quantitative treatment limitations on those benefits that are more restrictive than the predominant requirements or limitations that apply to substantially all medical surgical benefits in the same classification.... Plans or issuers are required to perform the parity analysis annually in years when a change in benefit design, cost-sharing structure, or utilization affects the analysis within a classification."

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