
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document affected by Public Law 107-116 Section 701(b)]
[CITE: 42USC300gg-5]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
   SUBCHAPTER XXV--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
 
                      Part A--Group Market Reforms
 
                      subpart 2--other requirements
 
Sec. 300gg-5. Parity in application of certain limits to mental 
        health benefits
        

(a) In general

                    (1) Aggregate lifetime limits

        In the case of a group health plan (or health insurance coverage 
    offered in connection with such a plan) that provides both medical 
    and surgical benefits and mental health benefits--

        (A) No lifetime limit

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

        (B) Lifetime limit

            If the plan or coverage includes an aggregate lifetime limit 
        on substantially all medical and surgical benefits (in this 
        paragraph referred to as the ``applicable lifetime limit''), the 
        plan or coverage 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 or coverage 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 or coverage 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 (or health insurance coverage 
    offered in connection with such a plan) that provides both medical 
    and surgical benefits and mental health benefits--

        (A) No annual limit

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

        (B) Annual limit

            If the plan or coverage includes an annual limit on 
        substantially all medical and surgical benefits (in this 
        paragraph referred to as the ``applicable annual limit''), the 
        plan or coverage 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 or coverage 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 or coverage 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 (or health insurance 
    coverage offered in connection with such a plan) to provide any 
    mental health benefits; or
        (2) in the case of a group health plan (or health insurance 
    coverage offered in connection with such a 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 or coverage, except as specifically provided in subsection 
    (a) of this section (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 (and group 
    health insurance coverage offered in connection with a group health 
    plan) for any plan year of a small employer.

                    (2) Increased cost exemption

        This section shall not apply with respect to a group health plan 
    (or health insurance coverage offered in connection with a group 
    health plan) if the application of this section to such plan (or to 
    such coverage) results in an increase in the cost under the plan (or 
    for such coverage) 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 or health insurance coverage, a 
    dollar limitation on the total amount that may be paid with respect 
    to such benefits under the plan or health insurance coverage 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 or health insurance coverage, 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 or 
    health insurance coverage 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 or coverage (as the case may be), 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 or 
    coverage (as the case may be), 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.

(July 1, 1944, ch. 373, title XXVII, Sec. 2705, as added Pub. L. 104-
204, title VII, Sec. 703(a), Sept. 26, 1996, 110 Stat. 2947.)


                            Prior Provisions

    A prior section 2705 of act July 1, 1944, was successively 
renumbered by subsequent acts and transferred, see section 238d of this 
title.


                             Effective Date

    Section 703(b) of Pub. L. 104-204 provided that: ``The amendments 
made by this section [enacting this section] shall apply with respect to 
group health plans for plan years beginning on or after January 1, 
1998.''
