Insurers Must Offer Equal Coverage for Addiction Problems


The US government issued new rules which address a long-standing inequity found in insurance coverage, between substance abuse disorder/mental health benefits and standard medical/surgical benefits.

The Story

If you receive health insurance through your employer, you probably participate in a group health plan. New rules, effective this summer, no longer allow these plans to limit benefits and require higher patient costs for people with substance abuse or mental health disorders. The rules, which implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, apply to businesses whose group health plan offers mental health and substance abuse disorder benefits and who have 50 or more employees.

What Does This Mean?

If substance abuse and mental health insurance benefits are a concern for you, you've probably noticed that receiving those benefits can be more expensive than standard medical treatments. For example, some insurance plans apply a separate deductible to substance abuse or mental health treatments, or impose lower coverage limits to those benefits. Group insurance plans that do this result in higher costs for participants who seek substance abuse treatment. This means that a $5,000 treatment for alcoholism will cost a plan participant more than a $5,000 treatment for diabetes, for example.

These new rules address this inequity by requiring that substance abuse and mental health benefits be treated equally to standard medical and surgical treatments, helping to ensure fair treatment for workers who need health care for substance abuse disorders.


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