Ohio

There are several sections of the state insurance law about parity. Some of these sections are only about coverage for mental health conditions, and there is another section that is about coverage for treatment of alcoholism.

This section and this identical section require individual plans, small employer fully-insured plans, large employer fully-insured plans, and self-insured plans (not exempted from state jurisdiction by ERISA ) to cover services for the following mental health conditions (as defined in the most recent version of the DSM ):

• Schizophrenia
• Schizoaffective disorder
• Major depressive disorder
• Bipolar disorder
• Paranoia and other psychotic disorders
• Obsessive-compulsive disorder
• Panic disorder

Coverage for these conditions must be “on the same terms and conditions” and “no less extensive” than coverage for other medical conditions. The section clarifies that this applies specifically (but not only) to inpatient care, outpatient care, medication, deductibles, copayments, lifetime limits, and lifetime maximums.

The section clarifies that plans are allowed to use non-quantitative treatment limitations (NQTLs) and does not state that the use of NQTLs has to be the same as what is in place for other medical conditions.

Plans are allowed to file for an exemption from this section of the law if they can prove that complying with this section of the law for 6 months caused cost increases of at least 1%.

For any other mental health condition not listed above, this section requires plans to offer optional coverage that includes a $550 annual maximum for outpatient care and nothing else.

This section requires small employer fully-insured plans and large employer fully-insured plans to offer optional coverage “alcoholism” but not any other substance use disorder.

If the optional coverage is chosen, plans must cover up to $550 per year for inpatient care, outpatient care, partial hospitalization, and residential treatment. Plans may use utilization review every 3 months to determine if treatment is medically necessary.