UBP blog


4 new mental health changes mean great news for Massachusetts HMO plan members

Health insurance plans cover your physical health as well as your mental health.  When an employee goes to see a doctor for a mental health condition, the condition is grouped into one of two categories.

It’s either biologically-based or non-biologically-based. Some people might ask “why do these categories matter to me?” The reason why they matter is fairly straightforward and simple.

If you have a mental health condition that’s biologically-based, you get an unlimited number of doctor visits covered by your health plan. If your condition is non-biologically-based, you get a limited number of covered visits.

The good news for Massachusetts Residents:

Starting July 1, 2009, all new Massachusetts HMO health plans moving forward will have changed the category of 4 different mental health conditions from non-biologically-based to biologically-based.

These 4 conditions are:

  1. Autism
  2. Eating disorders
  3. Substance abuse
  4. Post traumatic stress disorder (PTSD)

 What this means for employees:

Here is an example of what this will mean for your employees enrolled in a Massachusetts HMO. Let’s say you have an employee enrolled in your health plan with an autistic dependent child. Before July 1 of this year, his or her plan would only cover up to a pre-set maximum number of doctor visits (i.e. 24) for the child’s autism treatment. Now that autism is categorized as a biologically-based condition, there is no longer a maximum number.

The same is true for eating disorders, substance abuse and post traumatic stress disorder (PTSD).

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