By Pension and Benefits Editorial Staff
The Employee Benefits Security Administration (EBSA) investigated and closed 186 health plan investigations in 2019 (down from 285 in 2018), according to the FY 2019 Mental Health Parity and Addiction Equity Act (MHPAEA) Enforcement Fact Sheet. Of the 186 investigations, 71 investigations involved fully-insured plans, 91 investigations involved self-insured plans, and 24 investigations involved plans of both types (the plan or service provider offered both fully-insured and self-insured options).
The EBSA enforces Title I of ERISA, on behalf of 2.4 million private employment-based group health plans, which cover roughly 135 million participants and beneficiaries. EBSA relies on approximately 400 investigators to review plans for compliance with ERISA, including the MHPAEA.
Gnerally, if violations are found by an EBSA investigator, the investigator requires the plan to remove any offending plan provisions and pay any improperly denied benefits. To achieve the greatest impact, Investigators will also seek a global correction, working with the plans’ service providers to find improperly denied claims and correct the problem for other plans as well.
Investigation specifics. The Fact Sheet noted that 183 of the closed investigations involved plans subject to MHPAEA, which were reviewed for MHPAEA compliance. EBSA cited 12 MHPAEA violations in nine of these investigations. Of these nine investigations, one investigation involved a fully-insured group health plan, three investigations involved self-funded group health plans, two investigations involved partially self-funded group health plans, and three were service provider investigations.
EBSA benefits advisors answered 90 public inquiries, including 62 complaints, in FY 2019 related to MHPAEA (and answered 1,445 inquiries related to MHPAEA since FY 2011).
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