Effects of the Vermont Mental Health and Substance Abuse Parity Law

Table III.1: Overview of Mental Health/Substance Abuse Benefits Offered by Two Vermont Health Plans: 1997 Pre-Parity Baseline (Most Prevalent Plans by Line of Business)

  Kaiser/CHP Blue Cross Blue Shield of Vermont (BCBSVT)
  Compare/Share
(N = 45,857)
HMO 		Basic
(N = 26,702)
FFS 		Comprehensive
(N = 2,946)
FFS 		Vermont Freedom Plan Vermont Health Parnership
(N = 10,945)
POS 		The Vermont Health Plan
(N = 4,915)
HMO
Group
(N = 9,609)
PPO 		Individual
(N = 3,670)
PPO
COVERED SERVICES              
Mental Health (MH)              
Inpatient psychiatric care Yes Yes Yes Yes Yes Yes (2) Yes (2)
Nonhospital residential No Yes Yes Yes Yes Yes (2) Yes (2)
Partial hospitalization No Yes Yes Yes Yes Yes (2) Yes (2)
Outpatient therapy Yes Yes Yes Yes Yes Yes (2) Yes (2)
Substance Abuse (SA)              
Inpatient detoxification Yes Yes (1) Yes (1) Yes Yes Yes (2) Yes (2)
Outpatient detoxification Yes Yes (1) Yes (1) Yes Yes Yes (2) Yes (2)
Nohospital residential No Yes (1) Yes (1) Yes Yes Yes Yes
Partial hospitalization No Yes (1) Yes (1) Yes Yes Yes Yes
Outpatient counseling Yes Yes (1) Yes (1) Yes Yes Yes (2) Yes (2)
Methadone maintenance No No No No No No No
MENTAL HEALTH LIMITS              
Amount payable per year n.a. $5,000 (3,4) $5,000 (3) $5,000 (3) n.a. n.a. n.a.
Amount payable per lifetime n.a. $10,000 (3) $10,000 (3) $10,000 (3) n.a. n.a. n.a.
Inpatient Limits              
Inpatient MH days per year 30 days No limite No limit No limit 30 days 30 days 45 days
Inpatient MH days per lifetime No limit No limit No limit No limit No limit No limit No limit
Higher inpatient MH coinsurance No No No 50% No No $500 copay
Separate inpatient MH deductible No No No No No No No
Outpatient Limits              
MH visits per year 20 visits 50 No limit No limit 20 20 30
Different MH coinsurance None: visits 1-5
$25: visits 5-20		 No No 50% $10: visits 1-5
$25: visits 6-20		 $10: visits 1-5
$25: visits 6-20		 None: visits 1-5
$25: visits 6-30
Office coinsurance $10 (Compre)
$5 (Share)		 80% (5) 80% (5) 80% (5) $15 $5 $5
SUBSTANCE ABUSE LIMITS              
Amount payable per year n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Amount payable per lifetime n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Inpatient Limits              
Inpatient SA days per year 28 28 days per occurence 28 days per occurence 28 days per occurence 28 days per occurence 28 days per occurence 28 days per occurence
Inpatient SA days per lifetime 56 56 56 56 56 56 56
Higher inpatient SA coinsurance No No No 50% No No No
Separate inpatient SA deductible No No No No No No No
Outpatient Limits              
Outpatient SA hours per year 90 90 90 90 90 90 90
Outpatient SA hours per lifetime 180 180 180 180 180 180 180
Different SA coinsurance None: visits 1-4
$25: visits 5-20		 No No 50% $10: visits 1-5
$25: visits 6-20		 $10: visits 1-5
$25: visits 6-20		 None: visits 1-4
$25: visits 5-30
Office coinsurance $10 (Compre)
$5 (Share)		 80% (5) 80% (5) 80% (5) $15 $5 $5
Source: Kaiser/CHP and Blue Cross Blue Shield of Vermont contract files and additional information provided by the plans.
Note: The benefits shown on this table are for the most prevalent plans by line of business in 1997. The number of enrollees (shown in parentheses) reflects the number ever enrolled in 1997.
(1) BCBSVT Basic and Comp policies cover detoxification and rehabilitation services for alcoholism but not for other substances
(2) A referral is not required from a primary care provider (PCP); however, all MH/SA services require prior approval from the plan.
(3) The maximums apply to combined inpatient and outpatient mental health benefits
(4) For Basic/Major medical products, inpatient stays at nonpsychiatric hospitals are treated as medical claims and do not apply to the MH maximums
(5) Coinsurance applies after a deductible is met.
FFS = fee for service; HMO = health maintenance organization; Kaiser/CHP = Kaiser/Community Health Plan; n.a. = not applicable; PPO = preferred provider option.

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