At Risk Youth

New government rules that take effect July 1 should force insurance companies pay out more for treatments for mental diseases.

The new rules apply to people enrolled in group health plans from private employers or ones provided by state and local governments. The new rules will affect 140 million people, and increase insurance premiums by $25.6 billion over the next decade, according to government estimates. Businesses that employ under 50 people will be exempt.

The new rules provide that insurance companies cannot restrict coverage for diseases such as autism, schizophrenia, eating disorders, drug addiction, and alcoholism by limiting the number of hospital days and outpatient treatments.

Insurers can still require “prior approval and that a course of treatment is medically necessary.” However, insurance companies will no longer be able to require separate deductibles for medical/surgical expenses, and mental health/substance abuse charges. Policyholders would have a single deductible for both types of treatment.

“Patients with mental illness often have a general medical condition such as diabetes or high blood pressure that requires treatment at the same time,” said Irvin L. Muszynski, “which means that a combined deductible makes sense.” Muszynski is a lawyer with the American Psychiatric Association.

The new rules were developed by the Labor Department, the Department of Health and Human Services, and the Internal Revenue Service.