Mental Health 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:

• Major depression
• Bipolar (manic-depressive) disorder
• Panic disorder
• Anorexia or bulimia
• Obsessive-compulsive disorder
• Autism
• Schizophrenia
• Schizoaffective disorder
• 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.

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