What is mental health parity?

Mental health parity means equal coverage for health care. It requires your mental health coverage to be equal to or better than what it would be for similar medical and surgical coverage.

Before mental health parity laws, health plans could charge higher costs for mental health services than physical health services, or they could limit the number of visits allowed in a year for mental health.

Parity applies to both cost of treatment and how treatment is managed for mental health services:

Examples of cost of treatment

  • Copayments
  • Coinsurance
  • Deductibles
  • Out-of-pocket expenses

Examples of how treatment is managed

  • Prior authorization requirements
  • Not covering certain types of services
  • Access to medications
  • Number of visits covered

Not sure what some of these terms mean? Take a look at our glossary of health coverage terms for handy explanations.

Mental health parity

What parity means for you

We cover the diagnosis and treatment of severe mental illness in all of our members. This includes emotional disturbances in children, including behavioral health treatment for pervasive developmental disorders or autism. Depending on your plan, you may also have coverage for the treatment of other behavioral health conditions.

Log in to the Sharp Connect member portal and take a look at your latest Summary of Benefits and Member Handbook. Both of these resources will have more details about how your plan covers behavioral health services.

You don’t need a referral from your primary care doctor to get access to behavioral health services. However, only services offered through plan providers will be covered.

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Find out more about your behavioral health coverage

If you’re not sure or if you have questions about what type of coverage you have, call our Customer Care team at 1-858-499-8300 or contact your human resources department.

If you have questions or a complaint related to coverage for behavioral health conditions, give us a chance to help. Our Customer Care team is available to assist you Monday through Friday, 8 am to 6 pm at 1-858-499-8300. Or you can file a formal complaint with a grievance form online at any time.

Remember, we’re here to ensure that you have the best health care experience possible.

To learn more about the federal and state mental health parity laws, we recommend checking out these handouts from the Substance Abuse and Mental Health Services Administration and the California Department of Health Care Services.