Federal law prohthttryourprirrate health insuranee plan from
dirffiminating
agalnst you because yotr haveamental illntes, lncluding a sub,strnce use rli*Errder.
€overage for e ment*l heelth concern now must he equivalentto coverage for
physicel health problem.B, like hqsa[ rlissas€, diabete and cancer.
Under the federal "Mental HealthParifi/'law:
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tt
l[l:
You BrE efitiilBd to thB treatmeflt lrour
physician says is necestary for yqrr mentsl
health or substance use disorder. Your
health plan cannot r€quire you tD f6ii first
at less-expensive teatrrteflts il it does not
hsve lhe ssme "fuil first" requircment sr
sll other illnes.ses covered by yorr plan.
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With fuw exceptions your co-psyrflefil or
co-heuance {ar your mental health benelit
should not b6 hagher than ii is ior other
medical care, anel yu: slrould haue orily one
de&rctible and out-ol-pocket meximum
tlrat covers all of y,our health care.
You should have acc€Es to En
F
\for have the dgfit to appeal ywr planB
decision about youf canr tr ooverags.
You have the figiht to appeal the cla{m with
Stour plan srid with an in@endent reviw
orgmizatim. (Chock vri& your siile inzurance
cryrrnishnerk office: wnnn-naic"orgf
docunxnts/mernbet:_meif,rberct4*Et+dfl
@
When 1ro: visit a pcychistdstltrmedicstdfl
rnanagernent and tor psychotherapy on the
same dan you shorld pryaaty me cofaym€fit
ll you harre En dJt-of{etruork beneftin yrtr
pbn snd s€€ sr outd-fletui1rk pqrt*iaeist,
the hedth phn should reirbume yoii ftr
a porthn of the anrcunt you pstui for tfe
visit. lf th,e smount irru ile leamburserl b
sigrifkxntly les th*r the srnunt fte heslttl
phn FsIrB to dhs &cttrs $fio alt outdneturtd( this may be illegsl. \rhi cen see what
rlactrs are paid by checking the axplanatlrr
of benefib yur rcceive f*urn your plan"
'in n€trirod("
tsl he6l$ providw *rho:
is qualified to trgat your condithn
mefi
r
.
I
irss
t
g
can see yuu in a reffionable amount
of time si a hcatiori accessible
frurn your home.
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Mental ircalth-rEhted visih or teatnent
sfi.uld not rcquire prE-er&arizdion"
unless lour plan rcquircs pe-anthorizutim
for most otiH medicsl eBrE.
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Thenrrterof
visiE or hoepital dap shulld
not be linited, unless similar limihti:m aFFly tu
moct dher madical illnessan underycur plm.
Yauhealth phn shoutd pay even if yur
don't complete the tmatment or a pfor
rccarnmended cour36 of fedment.
Yawheafth plan is equircdtoprovide
ytu with a vwifter expltrIatiari o,t
hou h eualuded turr need for tednent
.
r
.
wfry it denied the chim
the bscis for its cwrclusion that the
fla complbs with feded law.
/
Catr r're iaderal gorrernnurtb Center
ior Qoruumer lrdormatfu:n and lnsrrance
Ouersight (CSllO) at 877-287.93?:l
axt 6.1565 or emeil ib Fublie Heglth
lnlerest Group, atso part of CCllO:
ptrigBcms.hhs.com
/
Csntact a heneflt advisor at the U"S.
Deparfnent of Labor Et 8ffS.4*{*3872
cr rrwua+kehsa-dol-gov
I
CaI )rour stEte irrursrice commissiofi€dc
offi ce (lBt Et
utrrsraic.olg/docurreaEi/
rnerft er*_rnen6,e*smpmt4Afl
Comrldslffi
Plwne:
1-AOO-927-4357