The rules, published in the Feb. 2 Federal Register, generally apply to group health plans and group health insurance issuers for plan years beginning on or after July 1, 2010.

. . . The regulations amend the definitions of medical/surgical benefits and mental health benefits and add a definition for substance use disorder benefits. Medical/surgical benefits are benefits for medical or surgical services, as defined under the terms of the plan or health insurance coverage, but do not include mental health or substance-use disorder benefits. Mental health benefits and substance-use disorder benefits are benefits with respect to services for mental health conditions and substance-use disorders, as defined under the terms of the plan and in accordance with applicable federal and state law.

The regulations also provide that plan terms defining whether the benefits are mental health or substance-use disorder benefits must be consistent with generally recognized independent standards of current medical practice. This requirement is included to ensure that a plan does not misclassify a benefit in order to avoid complying with the parity requirements.

The regulations explain the general parity requirement, which prohibits a plan (or health insurance coverage) from applying any financial requirement or treatment limitation to mental health or substance-use disorder benefits in any classification that is more restrictive than the “predominant” financial requirement or treatment limitation applied to “substantially all” medical/surgical benefits in the same classification. The general parity requirement applies separately for each type of financial requirement or treatment limitation (that is, for example, copayments are compared with copayments, and deductibles with deductibles).

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