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Benefits for Treatment of Eating Disorders – Can they be limited?

June 11, 2019

 

Recent legislation and agency guidance has emphasized that eating disorders are a mental health condition, therefore, the treatment of an eating disorder is a mental health benefit.   Coverage for eating disorders must be consistent with the federal mental health parity requirements.  If your health plan is subject to the Mental Health Parity and Addiction Equity Act (MHPAEA), it must provide consistency between medical/surgical benefits and eating disorder benefits as it pertains to annual or lifetime limits, financial requirements, and quantitative and non-quantitative treatment limitations.

For example, generally your plan could not require a participant seeking treatment for an eating disorder to go through a stricter approval process than what would be required of participants for treatment of medical/surgical procedures.

In addition, the ADA (American with Disabilities Act) may limit benefit restrictions or exclusions for a particular disability.  Past litigation alleges that the ADA prohibits health plans from providing unequal benefits for those with particular disabilities.  Also, the ADA generally prohibits plans from defining mental health benefits in a manner that makes distinctions based on a disability, and from excluding services for a particular disability – in this case, eating disorders.

The MHPAEA rules are complex, and although there are some exceptions for organizations such as the number of employees (50 or fewer), self-insured health plans, and grandfathered health plans, it is recommended to be careful before putting into place provisions that specifically restrict benefits for eating disorders.  It is always best to seek the advise of your broker, or legal counsel, with your questions and concerns.

For more information regarding Employee Benefits for your organization, or to speak with one of our advisors, email Billy MacNair, Senior Vice President at Brown & Brown Benefit Advisors at bmacnair@advisorsbb.com.

“This content is strictly informational and should not be used as specific advice on insurance products, legal, accounting and/or tax related matters. Insureds should always contact the appropriate licensed professional for their insurance, legal, accounting or tax needs.”


Brown & Brown Benefit Advisors