North Dakota

There are two sections of the state insurance law relevant to parity. There is a section about mental health coverage (26.1-36-9), and there is a section about substance use disorder coverage (26.1-36-8).

It is not possible to link directly to these sections. To find them click here (pdf | Get Adobe® Reader®) and scroll to the respective sections.

Large employer fully-insured plans and small employer fully-insured plans must cover mental health services. This section requires plans to cover the following each year:

• 45 day annual limit for inpatient care
• 30 hour annual limit for outpatient care
• No deductibles or copayments for the first 5 hours of outpatient care (a deductible is specifically allowed in the first 5 hours for high-deductible plans)
• Coinsurance after the first 5 hours of outpatient care cannot be greater than 20%
• 120 day annual limit for partial hospitalization
• 120 day annual limit for residential treatment (patients can exchange up to 23 days of inpatient care for 46 additional days of residential treatment)

Large employer fully-insured plans and small employer fully-insured plans must cover substance use disorder services. This section requires plans to cover the following each year:

• 60 day annual limit for inpatient care
• 20 visits annual limit for outpatient care
• No deductibles or copayments for the first 5 hours of outpatient care (a deductible is specifically allowed in the first 5 hours for high-deductible plans)
• Coinsurance after the first 5 hours of outpatient care cannot be greater than 20%
• 120 day annual limit for partial hospitalization (patients can exchange up to 23 days of inpatient care for an additional 46 days of residential treatment )

Plans can choose to provide coverage for residential treatment, but if they do, they must cover at least 60 days. However, if they cover residential treatment they can then reduce their coverage of inpatient care to 45 days, but they must allow patients to exchange up to 23 days of inpatient care for an additional 46 days of residential treatment.