For Consumers

Mental health parity

What is mental health parity?

Health plans that include medical and surgical services must cover medically necessary mental health services. See Washington State’s Mental Health Parity Act (leg.wa.gov).

What does this mean for you?

  • Your health plan’s deductible, copayments, coinsurance and out-of-pocket maximum must apply to all covered services, including mental health.
  • Your prescription drug benefits must cover medications used to treat mental health conditions just the same as other covered prescription drugs.
  • Health plans may not contain a blanket (also called “categorical”) exclusion for mental health services that are medically necessary.
  • Your health plan can’t deny or limit your benefits for mental health services based on your age, condition or because your treatment was interrupted or you didn’t complete it.

How to resolve benefit concerns with insurance companies

If you believe your insurer isn’t providing coverage for mental health services, file a complaint and we will review your concerns with the company.

If your health plan denies your claim for mental health services, you can appeal their decision.