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This notice must be provided to you under the requirements of the Mental Health
Parity Act of 1996 (MHPA) because the group health plan identified below is claiming the one percent increased cost exemption from the requirements
of MHPA. Under MHPA, a group health plan offering both medical/surgical and
mental health benefits generally can no longer set annual or aggregate lifetime
dollar limits on mental health benefits that are lower than any such dollar
limits for medical/surgical benefits. In addition, a plan that does not impose
an annual or aggregate lifetime dollar limit on medical/surgical benefits
generally may not impose such a limit on mental health benefits. However, a
group health plan can claim an exemption from these requirements if the plan's
costs increase one percent or more due to the application of MHPA's
requirements.
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This notice is to inform you that the group health plan identified below is claiming the exemption from the requirements of MHPA. The exemption is
effective as of the date below. Since benefits under your
group health plan may change as of the date below. It is important
that you contact your plan administrator or the plan representative identified below to see how your benefits may be affected as a result of your
group health plan's election of this exemption from the requirements of MHPA.
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Upon submission of this notice by you (or your representative) to the plan
administrator or the person identified below, the plan will provide
you or your representative, free of charge, a summary of the information upon
which the plan's exemption is based.
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Notice of Group Health
Plan's Exemption From the Mental Health Parity Act |
| Group
Health Plan Name: |
Plan Number: |
| Plan Administrator: |
Address: |
| City: |
| Telephone Number: |
State: |
| Zip Code: |
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For
Single-Employer Group Health Plans
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| Employer Sponsoring
Plan: |
Employer Identification
Number: |
| Telephone Number: |
Address: |
| City: |
| Effective Date of the
Exemption: |
State: |
| Zip Code: |
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This notice must be provided if a group
health plan uses the transition period under the requirements of the
Mental Health Parity Act (MHPA). Under MHPA, a group health plan
offering both medical/surgical and mental health benefits generally can
no longer set annual or aggregate lifetime dollar limits on mental
health benefits that are lower than any such dollar limits for
medical/surgical benefits. In addition, a plan that does not impose an
annual or aggregate lifetime dollar limit on medical/surgical benefits
generally may not impose such a limit on mental health benefits.
However, a group health plan can claim an exemption from these
requirements if the plan's costs increase one percent or more due to the
application of MHPA's requirements. Under MHPA, a plan that claimed the
one percent increased cost exemption prior to the issuance of the MHPA
interim regulations based on assumptions inconsistent with the MHPA
interim regulations may delay compliance with the parity requirements of
MHPA until a date no later than March 31, 1998.
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This notice is to inform you that the plan is utilizing the MHPA
transition period and that the plan is delaying compliance with the
parity requirements of MHPA until a time no later than March 31, 1998.
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Notice of Group Health
Plan's Use of Transition Period |
| Group
Health Plan Name: |
Plan Number: |
| Plan Administrator: |
Address: |
| City: |
| Telephone Number: |
State: |
| Zip Code: |
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For
Single-Employer Group Health Plans
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| Employer Sponsoring
Plan: |
Employer Identification
Number: |
| Telephone Number: |
Address: |
| City: |
| Signature
of Plan Administrator: |
State: |
| Date: |
Zip Code: |
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