Member Lawsuits

Translation:  If your plan has a NQTL that does not treat Mental Health and Substance Use Disorders in parity to Medical/Surgical, the member can sue for their adverse medical outcomes.

The financial nightmare scenario to employers is one where a member is trying to access mental health or substance abuse care but is denied certain care or drugs.  Assume the member then has an overdose or commits suicide.  In this scenario the employer/plan can be sued as liable if the denial of care was do to a non-allowed NQTL.

NQTL Comparative Analysis is all about finding and correcting any issues ahead of time.  

Learn more about MHPAEA Enforcement

IRS Penalties

Translation: The IRS can assess penalties of up to $100/per day per member until the plan determined to be in compliance.

The CAA includes a specific process to follow if the DOL’s review of a plan’s analysis indicates a parity violation. After the DOL’s determination, the plan must specify what actions it will take to correct the violation and provide an additional comparative analysis within 45 days showing plan compliance.

If the DOL then makes a final determination that the plan is still in violation, all plan enrollees must be notified as to the plan’s noncompliance within seven days.