Understanding mental health coverage under ERISA

On Behalf of | May 19, 2023 | ERISA

Amidst the clamor of today’s fast-paced world, the profound significance of mental health can sometimes elude our collective awareness. Mental health impacts every aspect of our lives, just as our physical health does, yet it’s often stigmatized.

While more people are becoming aware of the importance of mental health care, many are still unaware of the support available to them. For example, the Employment Retirement Income Security Act (ERISA) mandates that mental health benefits be on par with medical and surgical benefits. This means insurance plans must cover mental health conditions under the same terms and conditions as physical health conditions.

How to qualify for benefits?

Individuals must meet certain criteria to qualify for mental health benefits under an ERISA plan. It typically includes a mental health condition diagnosis. However, some plans may restrict the number of therapy sessions. Others may require pre-authorization for certain treatments. Some plans may also limit coverage to specific types of therapy or providers. The specific criteria can vary by plan, so reviewing the plan’s coverage documents and contacting the plan administrator with any questions is important.

Maximizing benefits

Under ERISA, plans may require pre-authorization for mental health services. You must obtain approval from your insurance provider before receiving certain treatments. Unfortunately, it can lead to delays or coverage denials if deemed medically unnecessary.

To maximize your benefits under the ERISA plan, take charge with these empowering steps.

  • Familiarize yourself with the specifics of your mental health coverage
  • Ensure that you understand the criteria and limitations for mental health benefits
  • Utilize the network of mental health professionals your insurance plan prefers to minimize out-of-pocket costs
  • Ensure treatments align with plan requirements
  • Seek pre-authorization when necessary

If you encounter difficulties accessing mental health care, advocate for your rights proactively. Document communication with your insurance provider. Also, keep records of treatment denials. You may also consider involving a mental health advocate or legal professional to support your case.

Your mental well-being matters. With knowledge and advocacy, you can ensure that ERISA works for you and that you are accessing the care you deserve on your journey toward mental wellness.

FindLaw Network