American’s with Disabilities Act (ADA) Amendments
- Effective October 3, 2009 for all large and small groups.
- Hearing Aids:
- Coverage of hearing aids will be standard.
- Dollar limits mirror Durable Medical Equipment (DME) and Prosthetics and vary by state and plan
- Limited to one device as follows:
- Connecticut every 12 months
- New Jersey every 24 months
- New York every 3 years
Mental Health/Substance Use Parity
- Effective October 3, 2009 for large (51+ lives) groups.
- The new law does not allow more restrictive financial requirements for mental health and substance use disorder coverage than for any other medical expense.
- It specifically states that deductibles, copayments, coinsurance, and out-of-pocket expenses must be in parity.
- A plan may still have an aggregate lifetime limit and an aggregate annual limit that is applied to both medical and mental health/substance use disorder benefits.
- The law also prohibits treatment limits on mental health and substance use disorder benefits that are more restrictive than those of medical/surgical benefits. The law specifically requires the following limitations to be in parity:
- Limits on frequency of treatment
- Limits on number of visits
- Limits on number of days of coverage
- Other similar limits on the scope or duration of coverage.
- Effective October 9, 2009 for individual plans, large, and small groups.
- Prevents dependent children covered under a group health plan from losing coverage if they are forced to take a medically necessary leave of absence from school