Mental Health Parity Notice

Examples of requirements or limitations that may be evaluated for parity include:

• Copayments, coinsurance, deductibles and other financial requirements
• Visit, day or other quantitative treatment limits
• Medical necessity criteria and utilization management requirements
• Prior authorization and concurrent review practices
• Provider admission, credentialing and reimbursement standards
• Formulary design, step therapy and quantity limitations

For more information, visit the CMS website and the DOL website .

CareFirst Parity Information and Disclosures

CareFirst BlueCross BlueShield (CareFirst) members can view their mental health and substance use disorder benefits by logging in to My Account . Members covered through CareFirst Third-Party Administrator (CFA/TPA) or administrative services only (ASO) arrangements should contact their employer for information about their coverage.

CareFirst maintains information regarding the processes, standards and other factors used to design and apply certain nonquantitative treatment limitations (NQTLs) to mental health and substance use disorder benefits and to medical and surgical benefits.

Members may request information about how certain coverage policies and benefit requirements are applied. View a summary of CareFirst's mental health parity practices.

Depending on your plan and request, information available may include:

• A general description of an applicable NQTL and the benefits to which it applies
• The factors and sources considered in designing or applying the NQTL
• An explanation of how the NQTL is applied to mental health or substance use disorder benefits and medical or surgical benefits
• Available findings or conclusions from CareFirst’s comparative review
• Other information required by applicable federal, Maryland, Washington, D.C. or Virginia law

Important

The documents available and the level of detail provided may depend on your health plan’s funding arrangement, CareFirst product, jurisdiction, the nature of the request and applicable law. Certain proprietary or confidential information may be protected from disclosure.

MHPAEA Comparative Analysis Reports by Jurisdiction

How to Request Information or Ask a Question

If you have questions about mental health parity or would like to request parity information, you may:

• Use the mental health parity or NQTL disclosure request
• Contact Member Services using the telephone number on the back of your member ID card

To help us provide the right information, please include:

• Name
• Member identification number
• The CareFirst plan or product
• The state where the coverage was issued
• A brief description of the information requested

Note: Do not send clinical records or other sensitive health information by unsecured email.

If You Think Your Claim or Benefits Were Handled Incorrectly

This notice does not replace your plan documents, an explanation of benefits, an adverse benefit determination notice, or your rights to appeal. If you believe a claim, authorization request or other benefit determination was handled incorrectly, follow the appeal or complaint instructions in the notice you received or contact Member Services for assistance.

You may also contact the appropriate state or District insurance regulator for information about consumer assistance programs and complaint rights. The regulator and complaint process may vary based on where your coverage was issued and whether your plan is fully insured or self-funded.

Additional Information

Plan Terms Control. Benefits are subject to the terms, conditions, exclusions and limitations of the applicable contract, certificate, evidence of coverage or summary plan description. If this notice conflicts with the governing plan document, the governing plan document controls, subject to applicable law.

Language and Accessibility Assistance. CareFirst provides language assistance and auxiliary aids and services in accordance with applicable requirements. Contact Member Services for help accessing this information in another language or format.

Mental Health Parity Laws

To learn more about MHPAEA and your health plan’s compliance with parity:

• The U.S. Department of Labor Employee Benefits Security Administration (EBSA) website has consumer information on health plans, or you can contact the EBSA toll-free at 866-444-3272.
• The U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services Center for Consumer Information & Insurance Oversight can be reached at 877-267-2323 ext.61565
• Maryland’s department of insurance website and contact information can be found on the National Association of Insurance Commissioners website.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) has additional information on their website.