Parity is the requirement that a health plan treat mental health and substance use disorder care no less favourably than it treats medical and surgical care. It applies across four things at once: what you pay, how many visits are allowed, how hard the plan makes it to get approved, and how well the network actually works.

The last two are where violations usually live, because they are invisible in a benefits summary. A plan can have identical copays on paper and still require prior authorization for therapy but not for physical therapy, or maintain a directory that produces appointments for medical care and dead ends for behavioral health.

In New York: state law goes past the federal act with rules specific enough to quote at a plan. Cost sharing for outpatient mental health treatment at a state-licensed facility may not exceed the plan’s primary care copay. At an OASAS-certified facility that participates in the plan’s network, an insurer may not require preauthorization for outpatient substance use disorder treatment and may not run concurrent review for the first two weeks of continuous treatment, up to 14 visits, and a policy covering prescription drugs must give immediate access without prior authorization to substance use disorder medications on the state list. Coverage explicitly includes autism and ADHD. Insurers must run a parity compliance program and certify it to the state annually, which is why a complaint that uses the word parity is routed differently from one that does not.

These state additions reach plans regulated by New York. A self-funded employer plan is governed by federal law instead, where the federal parity act still applies but the state cannot enforce it for you.

Complaints go to the Attorney General’s Health Care Bureau Helpline at 800-428-9071, the Department of Financial Services at 800-342-3736, or for self-funded plans the US Department of Labor at 866-444-3272.

Also called: mental health parity, MHPAEA, behavioral health parity. Full guide: Mental health parity in New York and how to use it.

More in Glossary of health coverage and billing terms

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  • MAGI (modified adjusted gross income) — MAGI, modified adjusted gross income, decides Medicaid, Essential Plan and marketplace eligibility and adjusts Medicare premiums. What counts, which year.
  • Prior authorization — Prior authorization is a plan's approval before it pays for care. Who asks for it, what a denial says, where the deadlines are, and New York's appeal route.
  • Network (in-network and out-of-network) — The set of doctors and hospitals your plan has contracted with. Outside it, you pay much more.

This page explains how the system works. It is not medical advice. More.