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discrimination in their workplace and enables their access to places of public accommodation. Congress
also passed a law in the 1990s requiring mental health parity in health insurance, but due to weaknesses
in that law, Congress replaced it with MHPAEA
2
in 2010. MHPAEA equalizes health insurance
reimbursement for expenses relating to medical and surgical treatment and treatment of MH/SUD
conditions.
In addition to the public policy expressed in the ADA and MHPAEA, tremendous advances have
been made in the treatment of MH/SUD conditions. New drugs and improved psychotherapy modalities
have made MH/SUD conditions more treatable and even curable for most people. Improvements in
diagnostics, especially in psychometric testing and radiologic imaging, have also enabled clinicians to
better understand mental illness and validate the legitimacy of patients’ symptom complaints. Thus, the
chronic nature of mental illness has been significantly reduced, and insurers’ concerns about validation of
disability benefit claims have lessened. There remains, however, a segment of the population suffering
from MH/SUD conditions who do not improve following treatment with a qualified provider and who are
no less disabled than individuals suffering from untreatable cardiovascular or neurologic conditions.
It is against this backdrop that the 2023 Council undertook a study of mental health parity in LTD
benefits. It examined the scope and impact of employee benefit plans’ limitations on LTD benefits for
MH/SUD conditions. It also studied the extent, prevalence, rationale and impact of these limitations on
disability benefits, including whether certain health conditions have been misclassified as being subject
to such limitations, and made several recommendations based on its findings.
The Council notes that MHPAEA, which requires parity for coverage of medical/surgical and
MH/SUD conditions, does not apply to LTD plans. However, one state (Vermont) has mandated mental
health parity in disability insurance
3
, and human rights laws in Canada
4
have been interpreted to mandate
mental health parity in disability insurance. The Council examined various aspects of this issue and heard
testimony from numerous stakeholders and experts, including psychiatrists, psychologists, actuaries,
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2
Pub. L. No. 110-343 §§ 511-512, 122 Stat. 3381 (codified at 26 U.S.C. § 9812, 29 U.S.C. § 1185a, 42 U.S.C. § 300gg-26).
3
State of Vermont, Department of Banking, Insurance, Securities and Health Care Administration, Revised HCA Bulletin
127: Discrimination Against Disability Due to a Mental Health Condition Prohibited in Disability Income Replacement
Insurance (October 22, 2008).
4
See Battlefords and District Co-operative Ltd. V. Gibbs, [1996] 3 SCR 566 (Supreme Court of Canada October 31, 1996).