
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 2, 2001]
[Document affected by Public Law 107-116 Section 701(c)]
[CITE: 26USC9812]

 
                     TITLE 26--INTERNAL REVENUE CODE
 
               Subtitle K--Group Health Plan Requirements
 
               CHAPTER 100--GROUP HEALTH PLAN REQUIREMENTS
 
                    Subchapter B--Other Requirements
 
Sec. 9812. Parity in the application of certain limits to mental 
        health benefits
        

(a) In general

                    (1) Aggregate lifetime limits

        In the case of a group health plan that provides both medical 
    and surgical benefits and mental health benefits--

        (A) No lifetime limit

            If the plan does not include an aggregate lifetime limit on 
        substantially all medical and surgical benefits, the plan may 
        not impose any aggregate lifetime limit on mental health 
        benefits.

        (B) Lifetime limit

            If the plan includes an aggregate lifetime limit on 
        substantially all medical and surgical benefits (in this 
        paragraph referred to as the ``applicable lifetime limit''), the 
        plan shall either--
                (i) apply the applicable lifetime limit both to the 
            medical and surgical benefits to which it otherwise would 
            apply and to mental health benefits and not distinguish in 
            the application of such limit between such medical and 
            surgical benefits and mental health benefits; or
                (ii) not include any aggregate lifetime limit on mental 
            health benefits that is less than the applicable lifetime 
            limit.

        (C) Rule in case of different limits

            In the case of a plan that is not described in subparagraph 
        (A) or (B) and that includes no or different aggregate lifetime 
        limits on different categories of medical and surgical benefits, 
        the Secretary shall establish rules under which subparagraph (B) 
        is applied to such plan with respect to mental health benefits 
        by substituting for the applicable lifetime limit an average 
        aggregate lifetime limit that is computed taking into account 
        the weighted average of the aggregate lifetime limits applicable 
        to such categories.

                          (2) Annual limits

        In the case of a group health plan that provides both medical 
    and surgical benefits and mental health benefits--

        (A) No annual limit

            If the plan does not include an annual limit on 
        substantially all medical and surgical benefits, the plan may 
        not impose any annual limit on mental health benefits.

        (B) Annual limit

            If the plan includes an annual limit on substantially all 
        medical and surgical benefits (in this paragraph referred to as 
        the ``applicable annual limit''), the plan shall either--
                (i) apply the applicable annual limit both to medical 
            and surgical benefits to which it otherwise would apply and 
            to mental health benefits and not distinguish in the 
            application of such limit between such medical and surgical 
            benefits and mental health benefits; or
                (ii) not include any annual limit on mental health 
            benefits that is less than the applicable annual limit.

        (C) Rule in case of different limits

            In the case of a plan that is not described in subparagraph 
        (A) or (B) and that includes no or different annual limits on 
        different categories of medical and surgical benefits, the 
        Secretary shall establish rules under which subparagraph (B) is 
        applied to such plan with respect to mental health benefits by 
        substituting for the applicable annual limit an average annual 
        limit that is computed taking into account the weighted average 
        of the annual limits applicable to such categories.

(b) Construction

    Nothing in this section shall be construed--
        (1) as requiring a group health plan to provide any mental 
    health benefits; or
        (2) in the case of a group health plan that provides mental 
    health benefits, as affecting the terms and conditions (including 
    cost sharing, limits on numbers of visits or days of coverage, and 
    requirements relating to medical necessity) relating to the amount, 
    duration, or scope of mental health benefits under the plan, except 
    as specifically provided in subsection (a) (in regard to parity in 
    the imposition of aggregate lifetime limits and annual limits for 
    mental health benefits).

(c) Exemptions

                    (1) Small employer exemption

        This section shall not apply to any group health plan for any 
    plan year of a small employer (as defined in section 4980D(d)(2)).

                    (2) Increased cost exemption

        This section shall not apply with respect to a group health plan 
    if the application of this section to such plan results in an 
    increase in the cost under the plan of at least 1 percent.

(d) Separate application to each option offered

    In the case of a group health plan that offers a participant or 
beneficiary two or more benefit package options under the plan, the 
requirements of this section shall be applied separately with respect to 
each such option.

(e) Definitions

    For purposes of this section:

                    (1) Aggregate lifetime limit

        The term ``aggregate lifetime limit'' means, with respect to 
    benefits under a group health plan, a dollar limitation on the total 
    amount that may be paid with respect to such benefits under the plan 
    with respect to an individual or other coverage unit.

                          (2) Annual limit

        The term ``annual limit'' means, with respect to benefits under 
    a group health plan, a dollar limitation on the total amount of 
    benefits that may be paid with respect to such benefits in a 12-
    month period under the plan with respect to an individual or other 
    coverage unit.

                  (3) Medical or surgical benefits

        The term ``medical or surgical benefits'' means benefits with 
    respect to medical or surgical services, as defined under the terms 
    of the plan, but does not include mental health benefits.

                     (4) Mental health benefits

        The term ``mental health benefits'' means benefits with respect 
    to mental health services, as defined under the terms of the plan, 
    but does not include benefits with respect to treatment of substance 
    abuse or chemical dependency.

(f) Sunset

    This section shall not apply to benefits for services furnished on 
or after September 30, 2001.

(Added Pub. L. 105-34, title XV, Sec. 1531(a)(4), Aug. 5, 1997, 111 
Stat. 1083.)
