BEHAVIORAL HEALTH & SUBSTANCE ABUSE INSURANCE RESOURCES
The Connecticut Insurance Department wants consumers to have the appropriate information and available resources when seeking behavioral health and substance abuse services through their health insurance plans.
- Know Your Insurance Plan – Find out what’s covered and how to get the care you need from your health plan.
- Make Informed Decisions – What you need to know about mental health coverage.
- Research First – Contact your insurer and learn about in-network providers.
- Seek “Medical Necessity” Approval – Except in an emergency situation, your health plan may require information from your doctor about the services you need.
- Determine Your Out-of-Pocket Expenses – Learn about costs for in-network and out-of-network providers and care.
- Review the Consumer Toolkit – Learn how to navigating behavioral health and substance abuse care through your health insurance plan
Consumer Resources:
- Behavioral Health Coverage and the ACA
- CDC Tips on Coping with Stress and Self-Care During COVID
- Child Health Development and Institute of Connecticut, Inc
- External Review Program – Frequently Asked Questions
- Frequently Asked Questions on Mental Health Parity Rights Under Your Health Insurance Plan
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FAST FACTS ABOUT MENTAL HEALTH PARITY LAWS
State: Enacted January 1, 2000, Connecticut law requires all individual and group health insurance policies covering hospital, medical-surgical, major medical and HMO coverage to provide mental health benefits.
Federal: The federal Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted in 2008 and mandates that large group plans be compliant with mental health parity if such mental health benefits are provided.
ACA: The federal Affordable Care Act, enacted on March 23, 2010, requires individual and small group plans beginning January 1, 2014, to cover mental health benefits, a provision already in effect under Connecticut state law and extends federal mental health parity protection to these plans.
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Other Resources:
- A Report on Mental Health Parity And Commercial Health Insurance Compliance
- CID Bulletin MC-24:MH/SUD Parity Submission Guidelines
- Consumer Report Card on Health Insurance Carriers in Connecticut
- Behavioral Health Consumer Tool kit
- Mental Health Parity Annual Compliance Survey Certifications
- Office of the Healthcare Advocate
- Protecting Behavioral Health For Consumers in Connecticut
- Summary of Federal Rules
- U.S. DOL EBSA MHPAEA Guidance
Qualified Clinical Review Vendors
The following vendors have been approved as Qualified Vendors for behavioral health utilization review criteria by the Connecticut Insurance Department pursuant to Conn. Gen. Stat. Sec. 38a-591(c)
- Health Integrated, Inc.
- MCG Health, LLC
- Change Healthcare
Bulletin HC-105: Behavioral Health Statutory Clinical Review Criteria Requirements
The Connecticut Insurance Department is here for you. Contact the department if your insurance company isn’t being helpful in answering your questions or paying your claims. If you have questions, please contact our Consumer Affairs Unit at:
860-297-3900
email: 
CT Insurance Department Consumer Brochure For All Your Insurance Needs
