New Hampshire

There are several sections of the state insurance law relevant to parity. They are summarized below in three parts: Behavioral health coverage; Biologically-based mental illness coverage; Autism coverage

This section requires individual plans, and large employer fully-insured plans to cover behavioral health services. However, there are different requirements for different conditions and different plans.

For substance use disorder services, this section only specifies that plans must cover inpatient care and outpatient care and that there may be annual maximums and annual limits in place, but it does not clarify what those maximums and limits should be.

For mental health services, small employer fully-insured plans and large employer fully-insured plans are required to cover inpatient care and residential treatment in a way that is “at least as favorable” as coverage inpatient care and residential treatment for other medical services. It also specifies (the wording is indirect) that financial requirements for inpatient care and residential treatment must be the “same ratio” as those for other medical services.

Plans must cover at least 15 hours per year for outpatient care.

For individual plans, deductibles and coinsurance for mental health services must be “at least as favorable” as those in place for other medical services. There is a $3,000 annual maximum and a $10,000 lifetime maximum for mental health services (however, the Affordable Care Act eliminates all lifetime maximums and annual maximums for most plans). This section specifies that this coverage is for inpatient care, outpatient care, and partial hospitalization.

This section also authorizes the Commissioner of the New Hampshire Insurance Department to issue regulations regarding the Federal Parity Law.

This section applies to small employer fully-insured plans and large employer fully-insured plans and specifies that it takes effect when coverage benefits from the above section are exhausted. It states that coverage for the following conditions must be “under the same terms and conditions and…no less extensive” than coverage for other medical conditions:

• Schizophrenia and other psychotic disorders
• Schizoaffective disorder
• Major depressive disorder
• Bipolar disorder
• Anorexia nervosa and bulimia nervosa
• Obsessive-compulsive disorder
• Panic disorder
• Pervasive developmental disorder or autism
• Chronic post-traumatic stress disorder

This section also authorizes the Commissioner of the New Hampshire Insurance Department to issue regulations regarding the Federal Parity Law.

The above section for “biologically-based mental illness” requires small employer fully-insured plans and large employer fully-insured plans to cover “pervasive developmental disorder or autism” services. This section further specifies plan requirements for this coverage.

Plans must cover the following:

• applied behavior analysis
• Prescription medications
• Direct or consultative services, by a licensed psychiatrist, licensed advanced practice registered nurse, licensed psychologist, or licensed clinical social worker
• Services provided by a licensed speech therapist, licensed occupational therapist, or licensed physical therapist

Plans must cover $36,000 annual maximum for applied behavior analysis for children at birth through age 12, and a $27,000 annual maximum for children and young adults age 13 through age 21.

Plans can review a child’s treatment plan once every 6 months.