Under the federal Mental Health Parity and Addiction Equity Act, large group plans (employer-based plans for employers with more than 50 full-time employees) that offer coverage for mental health or substance use disorders must provide benefits that are comparable to benefits for medical/surgical services. For example, copays, deductibles, limits on the number of visits, and utilization management standards for mental health benefits may not be more restrictive than benefits for medical/surgical services. Individual and small group policies (employer-based plans for employers with 2 to 50 full-time employees) issued on or after January 1, 2014, will also be required to comply with this federal law.
If you think that your health insurance carrier has not given you comparable benefits, you have the right to file a complaint with the Maryland Insurance Administration (MIA) or through your carrier’s internal appeal process.* Complaints filed with the MIA must be received in writing and include a signed consent form.
Maryland Insurance AdministrationAttn: Consumer Complaint InvestigationLife and Health/Appeals and Grievance200 St. Paul Place, Suite 2700Baltimore, MD 21202
Telephone: 410-468-2260 or 800-492-2260TTY: 800-735-2258Fax: 410-468-2270 or 410-468-2260(Life and Health/Appeals and Grievance)www.insurance.maryland.gov
The Health Education and Advocacy Unit (“HEAU”) of the Attorney General’s Office is available to assist you in filing a complaint with the MIA or your carrier. You may contact HEAU at:
Office of the Attorney GeneralHealth Education and Advocacy Unit200 Saint Paul Place, 16th FloorBaltimore, MD 21202
Telephone: 410-528-1840 or 877-261-8807Fax: 410-576-6571
You may request a referral to a specialist or non-physician specialist that is not a part of your health insurance carrier’s provider panel if:
i) you require specialized health care services or medical care; andii) your carrier:a. does not have a specialist or non-physician specialist with the professional training and expertise to treat or provide health care services for your condition or disease; orb. cannot provide reasonable access to a specialist or non-physician specialist to treat or provide health care services for your condition or disease without unreasonable delay or travel.**
You are entitled to obtain a copy of your health insurance policy or contract. If you would like a copy, you should contact your carrier.*** Both the federal Center for Medicare and Medicaid Services, which enforces the law as it affects non-federal governmental plans, and the federal Department of Labor, which enforces the law as it affects private large-group plans, have fact sheets that provide more information about this law, including what types of plans are required to comply with it. The Center for Medicare and Medicaid Services’ fact sheet can be viewed here. The Department of Labor’s fact sheet, along with other helpful information, can be accessed here.
For more information regarding your rights and obligations under your insurance policy or contract, visit the Maryland Insurance Administration’s website.About the Maryland Insurance AdministrationThe Maryland Insurance Administration (MIA) is an independent State agency charged with regulating Maryland’s $26 billion insurance industry. For more information about the MIA, please visit www.insurance.maryland.gov or follow us on Facebook at or on Twitter at @MD_Insurance.
* You also have the right to file a complaint with the MIA if you are denied coverage for health care services, whether for mental health, emotional disorders, and drug and alcohol abuse or treatment for physical illnesses. For more information regarding this process go to the MIA’s website at www.insurance.maryland.gov.
** Under Maryland law, any individual entitled to health care benefits under a policy or plan issued or delivered in Maryland, may request a referral to a nonparticipating specialist if these conditions are met, regardless of whether the policy is issued on a group or individual basis or the size of the policyholder’s employer.
*** All policyholders, regardless of whether the policy is issued on a group or individual basis or the size of the policyholder’s employer, are entitled to a copy of their health insurance policy or contract, upon request, from the carrier.
200 St. Paul Place, Suite 2700, Baltimore, MD 21202
410-468-2000 | 1-800-492-6116 (toll free) | 1-800-735-2258 (TTY)