California health insurance -
insurance in California - Mental
Health and California health plans
Benefits and the California Health Plan
California has been pretty progressive in terms of how Mental
Health issues are addressed from a health insurance perspective.
In 1999, California passed the Mental Health Parity bill which
is really an early predecessor for other State laws and the
eventual Federal law to follow. It set the stage for
planting mental health issues and treatment firmly within the
confines of health insurance in California. Let's take a
look at how mental health is addressed in California.
Mental Health Parity of 1999 was a watershed moment.
Essentially it stated that for certain designated conditions for
adults and a wider definition for children, benefits will be
treated as if medical. This means that the medical
benefits a California health insurance plans would apply
equally. Before mental health parity, mental health issues
had a separate and much more limited set of benefits. This
really posed an issue with medication costs and therapy visits
which can be both expensive and ongoing. The listed set of
conditions that qualify under Mental Health Parity in California
are as follows:
Bipolar (manic-depressive) disorder
Anorexia or bulimia
Children's severe emotional disturbances
Pervasive developmental disorder
The fact that these conditions are now covered under medical
benefits is great news for those people that are already
enrolled but an issue for people that are applying for health
insurance with existing (or pre-existing) mental health issues.
Pre-existing mental health issues are now more closely
considered when applying for coverage. Children are now
guaranteed issue regardless of medical or mental health but the
rates charged can increase base on pre-existing conditions.
For adults, until the Exchange is set up, they can be declined
individual family health insurance in California due to mental
health conditions depending on the severity and treatment
required. The big question mark is medication cost and
therapy visits. Brand name medications for the two most
common mental health issues anxiety and depression can be very
expensive and last long term. Therapy visits are generally
quite a bit more expensive than general doctor visits and there
can be multiple visits per month.
There are options available for uninsured people who are
unable to qualify for medically underwriting health insurance
due to mental health issues. You can find more detail
here. These different options are likely stop-gaps till
the Health Reform Exchange is in place Jan 1st, 2014. At
that point, individual and family health insurance in California
will be guaranteed issue which means that people will not be
declined due to health or mental health conditions. The
costs will likely increase but there may be subsidies available
to help offset the increase based on income levels.
What if your condition is not on the list of covered mental
health conditions? Substance abuse is a very obvious hole
in the above listed conditions which is pretty surprising from
our point of view. Each carrier and plan will have
different benefits for non-mental health parity conditions.
We commonly see family or marriage counseling and of course,
substance abuse fall into this category although substance abuse
will generally have it's own break-out benefit. Check the
policy and brochure to better understand how a given policy will
handle these benefits. They will generally not be as rich
as the core medical benefits unfortunately and this may be a
determining factor of whether to go with a group option (if
available) where said benefits tend to be richer.