Mental Health Parity Disclosure Request

This document is about a form that can be used to request information from an employer-sponsored health plan or an insurer regarding limitations that may affect mental health or substance use disorder benefits. It provides background information on the Mental Health Parity and Addiction Equity Act, which requires that coverage limits applied to mental health and substance use disorder benefits be comparable to those applied to medical and surgical benefits. The form allows the user to request general information about coverage limitations or specific information about limitations that may have resulted in the denial of their benefits. The plan is required to provide the requested information within 30 calendar days.