Updated: March 24, 1999

Last year the legislature established a task force to look into the issue of equality between insurance coverage of mental health compared to that of physical health. House Bill 149 contains the recommendations approved by the majority of the task force membership.

This legislation requires businesses with 20 or more employees that provide health insurance benefits for their staff to provide mental health and substance abuse insurance benefits that are equal to those for physical health. Specifically, an insurance plan providing health care cannot:

• require different deductibles, coinsurance or copayments;
• use different claim payment methodologies;
• require different pre-notification of treatment or second opinions;
• limit coverage by provisions for such things as preexisting illnesses that are not applicable to other covered illnesses, or limit treatment services to either inpatient or outpatient services;
• deny reimbursement solely because treatment was interrupted or not completed; and
• impose different annual or lifetime benefit limits, maximum out-of-pocket expenses, day limits or number-of-visit limits.

Coverage for substance abuse is included with mental health coverage because it is common for these ailments to co-exist. People suffering from mental illness may unconsciously attempt to "self-medicate" with drugs or alcohol. For this reason, it is inappropriate to treat one disorder and not address the other. Including substance abuse coverage allows the entire disorder to be treated rather than just one portion.

Recognizing that costs can be contained through managed care, the legislation does not prohibit the involvement of a managed care organization in providing mental health and substance abuse treatment. However, the involvement may not diminish or negate the legislation's requirements, nor may the organization use administrative or clinical protocols that reduce access to treatment.

Mental health disorders cost the economy hundreds of thousands of dollars each year. Whether for treatment, social services, disability payments or lost productivity, the costs are staggering. Many mental disorders are treatable. With early and appropriate treatment, many individuals are able to remain at work and continue to be productive, contributing members of society. To date, however, this treatment has not been readily accessible or financially viable. Even those with coverage normally have such low coverage that they soon run out of benefits and are forced to either discontinue treatment or leave their place of employment to qualify for public assistance.

House Bill 149 requires coverage for mental health disorders equal to coverage for medical health disorders. It recognizes that individuals with any type of medical disorder should be allowed access to coverage.