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Toll-Free: (800) 821-2251
Juneau: (907) 465-4460
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Fax: (907) 465-4668
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doa.drb.mscc@alaska.gov

Jim Puckett
Director and Administrator

Susan Stopher
Editor

AlaskaCare Employee Health Plan: Notice of Opt Out

Mental Health Parity Information

Under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), group health plans generally must comply with the requirements listed below. However, the law also permits State and local governmental employers that sponsor health plans to elect to exempt a plan from these requirements for any part of the plan that is self-funded by the employer.

IMPORTANT: This opt out will not affect the mental health benefits currently available to AlaskaCare Employee health plan members and dependents.

The State of Alaska has elected to exempt the AlaskaCare Employee Health Plan from the following requirement:

  • Parity in the application of certain limits to mental health benefits. Group health plans that provide both medical and surgical benefits and mental health or substance use disorder benefits must ensure that financial requirements and treatment limitations applicable to mental health or substance use disorder benefits are no more restrictive than the predominant financial requirements and treatment limitations applicable to substantially all medical and surgical benefits covered by the plan.

The exemption from these requirements will apply during the 2013 plan year beginning July 1, 2012 and ending June 30, 2013. The exemption election may be renewed for subsequent plan years.

The exemption is being made following review of the mental health parity legislation and subsequent health care reform legislation by the Health Benefits Evaluation Committee (HBEC), a long standing labor management committee dedicated to a review of the employee health plan. The members of the HBEC voted to recommend opting out of the requirements of mental health parity to allow time to conduct a thorough review of this legislation in conjunction with the health care reform legislation. It is the intention of the committee and the State to continue reviewing the requirements as more guidance becomes available from the federal government on both mental health parity and health care reform before making a determination on any changes to the current mental health coverage.

The current coverage is:

Mental Disorders

Treatment of a mental disorder received through a plan referral is paid at normal plan benefits following the deductible. Treatment received without a plan referral is paid at 50% for up to 30 visits per benefit year.

Chemical Dependency

Treatment of chemical dependency is paid at normal plan benefits following the deductible. If treatment is received without a plan referral, the first $400 of inpatient treatment expenses and the first $200 of outpatient treatment expenses are not covered. Benefits for chemical dependency treatment received without a plan referral are limited to the amounts set by Alaska statute, currently $16,380 every two consecutive benefit years and $32,750 per lifetime. These amounts are subject to change.

Based on the limited guidance provided thus far, the changes required by the mental health parity legislation to the AlaskaCare employee plan would be related to reimbursement of treatment received without certification or without following plan referrals such as receiving care from a non-network provider. The AlaskaCare Employee plan already meets the requirements of the legislation for treatment that is certified and received from a network provider. Since July 2009, just under 3000 employee AlaskaCare members have received mental health services through the plan, and only 50 of those would have received higher reimbursements under the federal mental health legislation.

Additional information regarding the benefits provided by the AlaskaCare Employee Health Plan is available from the AlaskaCare Web site or by calling the Benefits Section at (800) 821-2251 or (907) 465-8600.

Mental health services available to AlaskaCare Retiree Health Plan members and dependents remain unchanged. Information about the mental health service benefits provided by the
AlaskaCare Retiree Health Plan is available from the AlaskaCare Web site or by calling the Benefits Section at (800) 821-2251 or (907) 465-4460.

This electronic newsletter is intended for employees who are covered by the State of Alaska’s AlaskaCare Employee Health Plan. If you have received this in error, please disregard.

http://doa.alaska.gov/drb/alaskaCare/retiree/index.html