MHPAEA Protections: NQTLs and QTLs

MHPAEA requires that insurers meet mental health parity standards in two areas: quantitative limits and non-quantitative limits.

Plans must apply comparable financial requirements (such as copay, coinsurance, deductible) for mental health/substance use disorder and medical surgical care.

The number of outpatient visits or inpatient days covered must be comparable for mental health/substance use disorder and medical surgical care.

Prior authorization requirements for mental health/substance use disorder services must be comparable to or less restrictive than those for medical surgical services.

These standards are applied according to classifications of benefits:

Inpatient / in-network
Inpatient / out-of-network
Outpatient / in-network
Outpatient / out-of-network
Emergency care
Prescription drugs