Legislating Equity

Some version of House and Senate bills aimed at enhancing mental-health coverage should pass during the current congressional session. Key features:

Deductibles, copays, out-of-pocket expenses, and annual and lifetime coverage. Can be no more restrictive than the terms for medical and surgical benefits.

Substance-abuse treatment. When offered, must be on a par with medical coverage. House bill requires coverage for alcohol and drug-abuse treatment.

Covered illnesses. The House version requires coverage for diagnoses of all conditions listed in the DSM-IV, the bible of mental health. The Senate bill doesn't specify covered conditions.

Self-insured plans. Both bills require employers that self-insure to cover mental and medical conditions equally.

Out-of-network benefits. The House bill requires out-of-network coverage if it's provided for medical care; that coverage must meet parity requirements. The Senate bill doesn't require out-of-network benefits, saying only that if there are such benefits, they be in parity with medical coverage.

Small businesses. Those with 50 or fewer employees remain exempt in both bills from parity requirements.