The Mental Health Parity Act (MHPA)

As required by federal law, the Southern California IBEW-NECA Active Health Plan is required to furnish you with information on the Mental Health Parity Act, or MHPA for short. Generally speaking, the purpose of the MHPA is to require health plans that offer mental health benefits, to provide parity in the application of lifetime dollar limits on mental health benefits in the same manner as provided for medical/surgical benefits.

There are however many other provisions of the law which also allow health plans flexibility. For example, there is no requirement that health plans even provide mental health benefits. Also, this law does not apply to benefits for substance abuse or chemical dependency.

Another important aspect of this law is that a health plan can choose to remove mental health benefits from their core medical plan, and offer a separate mental health plan (called a "carve out") with a totally separate set of benefits. For example, the plan can require that all hospital stays be approved, and further that the number of days of coverage be limited. There can also be limits on the number of outpatient visits for psychotherapy allowed under the plan.

Below is a simplified explanation of the benefits you are entitled to for mental health benefits under the Southern California IBEW-NECA Active Health Plan.

Kaiser Participants

Kaiser members will receive benefit coverage for the diagnosis and medically necessary treatment of serious emotional disturbances (SED) of a child and severe mental illnesses (SMI), of a person of any age. Covered benefits for the nine specific diagnoses are as follows: schizophrenia, schizo affective disorder, bipolar disorder, major depressive disorder, panic disorder, obsessive-compulsive disorder, pervasive developmental disorder, anorexia and bulimia nervosa.

If you would like to have The Evidence of Disclosure booklet from Kaiser that will have a complete explanation of benefits, contact Kaiser Member Services Department to request a new Evidence of Disclosure for the current plan year.  If you have additional questions, you should contact the Kaiser Membership Services Department.

PacifiCare and Indemnity Plan Participants:

Refer to Separate Summary Plan Description - Included in this Booklet for Easy Reference
PacifiCare and Indemnity Plan participants are covered for mental health and chemical dependency benefits under a separate stand alone plan called "Integrated Member Assistance Program and Managed Mental Health & Chemical Dependency Benefits Program." The Summary Plan Description for this plan is included in the Table of Contents subtitle "Mental Health & Chemical Dependency Benefit Program".

The plan is administered by PacifiCare Behavioral Health. If you are in need of mental health or chemical dependency benefits, refer to this separate Summary Plan Description and contact PacifiCare Behavioral Health directly at the toll-free number provided. Of course, if you need further assistance or have questions you can always contact the Southern California IBEW-NECA Health Trust Fund Administrative Office.