- Identify benefit packages.
- Use a standard to define benefits as either
- Medical and surgical.
- Mental health and substance use disorder.
- Classify benefits
Benefit Areas Requiring Parity
- Aggregate lifetime limits and annual dollar limits
- Financial requirements and quantitative treatment limitations
- Non-quantitative treatment limitations
Identifying Benefit Packages for Parity Compliance
A benefit package is a unique set of benefits, financial requirements or both for medical and surgical needs or mental health and substance use disorder needs. The parity compliance analysis for financial requirements and quantitative and non-quantitative treatment limitations is conducted by benefit package.
The state chose a generally recognized independent standard of current medical practice to identify which benefits are mental health and substance use disorder and which are medical and surgical benefits.
Parity requirements for financial requirements and quantitative and non-quantitative treatment limitations apply by benefit classification: inpatient, outpatient, emergency care, prescription drugs.