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Mental Health and Substance Abuse Disorder Toolkit

Understanding your health insurance coverage for mental health and substance abuse disorder benefits can be complicated or difficult to navigate. This toolkit may be helpful in better understanding your coverage.
 
The Law:
 
The Federal Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted into law in 2008. MHPAEA generally requires parity between benefits for mental health and substance abuse disorders and benefits for medical and surgical treatments under certain health plans. Ohio also has a law that requires coverage for certain biologically based mental illnesses. Both MHPAEA and the state law work together to help achieve parity among mental health benefits and medical and surgical benefits.
 
Additional Information regarding MHPAEA and Ohio Law:
 
ODI’s Role in Regulating MHPAEA:
 
ODI is tasked with regulating and enforcing laws relating to the business of insurance. ODI oversees insurance policies, premium rates, company solvency and helps consumers that have questions or complaints regarding their insurance coverage. Specifically related to MHPAEA, oversight takes many forms, and involves many different divisions of ODI.  However, ODI has three main divisions that help to oversee and enforce MHPAEA and state mental health law.
  • Product Regulation and Actuarial Services: This division is the first to see a proposed insurance product and the staff in this division reviews it for compliance with MHPAEA, state mental health and other applicable laws. It is during this process that the reviewers will note and ask about provisions in the insurance contract, if any, that appear to violate the law and/or mislead or deceive the consumer. In addition, this division also conducts the actuarial review to ensure that the premium rates are actuarially justified. 
  • Consumer Services: Consumer services is the first contact most consumers will make with ODI if the consumer has a question about their insurance plan, is filing a complaint, or has a general insurance inquiry. If a consumer has a question about their mental health or substance use disorder benefits or is alleging a violation of MHPAEA, this is the division that would handle the inquiry or complaint. To speak to a consumer services representative, please call the ODI hotline at 1-800-686-1526.In addition to assisting consumers, the division also serves helps to track trends in complaints to assist ODI in monitoring companies’ compliance with MHPAEA, and other insurance laws.  
  • Market Conduct: Market conduct monitors compliance with Ohio Insurance laws and regulation by examining insurance companies’ business practices, such as underwriting, marketing and claims handling. The division gathers information from a variety of sources, including consumer complaints, company filings and the NAIC to identify issued that need to be evaluated further, such as MHPAEA compliance.
Additional Information Regarding ODI’s Role in Regulating MHPAEA:
 

Consumer Information:

Understanding your Coverage:

Understanding the type of plan you have will help determine what mental health and substance abuse disorder benefits coverage you have. Use the following coverage chart to help you learn what type of coverage you may have under your plan. MHPAEA Coverage Chart
 
If you are unsure of what type of plan you have and if it offers mental health and substance abuse disorder benefits you can:
  • Check your certificate of coverage issued by your insurer or provided by your employer
  • Contact your human resources office
  • Contact your insurer directly
  • Contact your insurance agent
  • Contact ODI’s Consumer Hotline at 1-800-686-1526
 
Filing a Complaint:
If a consumer is unable to resolve a complaint with his/her insurer, they may contact the Consumer Services Division (CSD) at 1-800-686-1526. When an individual files a complaint, CSD will take a number of steps to begin working on the case to identify if there has been a violation of the law. If a complaint comes to ODI but is outside its jurisdiction, CSD will redirect the consumer on where to file the complaint.
 
For questions or for help in filing a claim contact ODI’s Consumer Services Hotline at 1-800-686-1526
  • Individuals with a self-insured plan can filed a complaint with the Department of Labor by calling 859-578-4680 or by visiting www.DOL.gov
  • Individuals with Medicaid can file a complaint with the Ohio Department of Medicaid by calling the consumer hotline 1-800-324-8680 or by visiting www.medicaid.ohio.gov
 
 Additional consumer information on how to file a complaint:
 
Advocate Information:
 
As an enforcement agency, it is necessary to have specific information in order to identify violations of law and require appropriate remedies. However, ODI understands that there may be times an individual is unable or unwilling to file a complaint. In order to assist advocates and stakeholders, ODI has developed a process to  utilize information from third parties that provide sufficient detail to allege a violation of law and allow for follow-up by ODI.  At a minimum, information provided to ODI must contain at least:
  • A plan or policy number
  • Name of the insurance company
  • A detailed description of the complaint or what happened – it is NOT enough to simply say the insurance company is violating the law
 
This information should be submitted to the following ODI Contact:
OMBUDSMAN
 
Advocates should know that any information sent to the Ombudsman will not be considered an individual complaint. ODI will utilize any information sent to the Ombudsman to track trends relating to a specific insurer, a geographic area or other trend that would indicate a  possible violations of insurance law.
 
Annual Reports:
 
 
 
 
 
 
 
 
 

Ohio Department of Insurance
50 W. Town Street, Third Floor - Suite 300
Columbus, Ohio  43215
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John Kasich, Governor | Jillian Froment, Director
General Info: 614-644-2658 | Consumer Hotline: 800-686-1526
Fraud Hotline: 800-686-1527 | Medicare Hotline: 800-686-1578
Consumer Affairs