Mental Health and Substance Use:
Treatment Exclusions in Employers' Health Insurance Coverage
GAO-12-761R, May 31, 2012
- Accessible Text:
What GAO Found
In summary, this report provides information on the incidence of treatment exclusions for MH/SU for the 2011 or 2010 plan year and the 2008 plan year for employers that responded to our survey. In total, for the 2011 or 2010 plan year, of the 96 employers that responded to our question about whether their most popular plan excluded coverage for any specific treatments related to MH/SU, 39 employers reported excluding a treatment. In comparison, for the 2008 plan year, of the 81 employers that responded to our question about whether their most popular excluded coverage for any specific treatments related to MH/SU, 27 employers reported excluding a treatment.
Why GAO Did This Study
On November 30, 2011, we issued a report entitled Mental Health and Substance Use: Employers Insurance Coverage Maintained or Enhanced Since Parity Act, but Effect of Coverage on Enrollees Varied. The report was written to fulfill a mandate in the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) that required us to examine trends in coverage for mental health conditions and substance use disorders (MH/SU). As a follow-up to the report, Congress asked us to provide additional information about plans treatment exclusions for MH/SU.
The information about treatment exclusions for MH/SU was based on survey data that we collected for our report to determine the extent to which employers covered MH/SU during the plan year in effect at the time of our surveyeither 2011 or 2010and in 2008. We surveyed a stratified random sample of small, medium, large, and very large employers about their most popular health plans for either the 2011 or 2010 plan year, as well as for 2008. We fielded our web-based survey between May 18, 2011, and July 1, 2011, to 707 employers, selected from the sampling frame we developed using the Lexis Nexis corporate database. We received usable responses from 168 employers, after following up with nonrespondents to encourage their participation, for a 24 percent response rate. All 168 employers offered coverage of mental health conditions, substance use disorders, or both, in either the 2011 or 2010 plan year, 2008 plan year, or both plan years. Given our overall response rate of 24 percent, our survey results are not generalizable. Rather, the survey responses provide information limited to responding employers coverage of MH/SU in the 2011 or 2010 plan year and 2008 plan year. We did not verify the accuracy of the employers responses or assess compliance with MHPAEA.
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