Date: October 8, 2008
For more information contact: Jim Guidry, (608) 264-6239 or jim.guidry@wisconsin.gov

Commissioner praises passage of mental health parity legislation

Madison, WI—Wisconsin Commissioner of Insurance Sean Dilweg hailed the passage of mental health parity legislation by Congress last week. The legislation, which was a part of the larger Emergency Economic Stabilization Act of 2008, was passed by Congress on October 3, 2008, and immediately signed by the President.

"This is a victory for Wisconsin consumers. It will greatly improve access to mental health and substance abuse treatment services. This provides consumers the same level of coverage for these services as would be available for their treatment of other medical conditions," said Dilweg. "Individuals diagnosed with a mental illness are too often limited in their ability to access treatment due to insufficient coverage."

The new federal mental health parity law requires employers offering mental health and substance abuse benefits to cover those benefits at the same level they cover physical illnesses. The new law includes employers that self-fund their health care expenses and excludes small employers with between 2-50 employees. The bill requires parity in co-payments, deductibles, coinsurance, out-of-pocket expenses, limits on doctor visits and hospital stays, and annual and lifetime limits on coverage. Current Wisconsin law requiring insurers to cover a minimum level of mental health and alcohol and other drug abuse treatment (AODA) remains in effect. Earlier versions of the federal legislation contained language to preempt state insurance mental health and substance abuse insurance coverage laws.

"In July 2007, I testified before Congress in support of mental health parity legislation," said Dilweg. "I strongly argued against the inclusion of preemption language that stood to compromise stronger insurance mental health coverage and AODA treatment provisions already in place in Wisconsin and other states. I'm pleased to see that the preemption language was not included in this legislation."

Current state law requires that group health insurance policies, in total for inpatient, outpatient and transitional mental health and AODA services, cover at least $7,000 in services a year. The new federal law allows an insurer to decline to include any coverage of these services but requires an insurer that does provide the coverage to do so at the same level as coverage of physical illness. State law, however, will continue to require insurers to cover a minimum level of mental health and AODA treatment if the insurer offers coverage for treatment of physical ailments.

Employers that self-fund health benefits are not subject to the state required minimum level of mental health and AODA treatment coverage requirement but are newly required under the federal law to provide parity in mental health and AODA benefits if they choose to provide coverage of such benefits.

To view Commissioner Dilweg's July 7, 2007, testimony to the House Subcommittee on Health, Employment, Labor and Pensions, please visit the subcommittee Web site at: http://edlabor.house.gov/testimony/071007SeanDilwegTestimony.pdf.

More information about mental health and substance abuse coverage is available from OCI. The OCI publication Fact Sheet on Mandated Benefits for the Treatment of Nervous and Mental Disorders, Alcoholism and Other Drug Abuse (PI-008) can be ordered free from the agency by writing to OCI Publications, P.O. Box 7873, Madison, WI 53707-7873, calling 800-236-8517 or visiting the OCI Web site at oci.wi.gov.

Created by the Legislature in 1871, Wisconsin's Office of the Commissioner of Insurance (OCI) was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI's mission is to lead the way in informing and protecting the public and responding to its insurance needs.