All Pennie plans cover mental health and substance abuse services as essential health benefits.
All plans must cover:
- Behavioral health treatment, such as psychotherapy and counseling
- Mental and behavioral health inpatient services
- Substance use disorder (commonly known as substance abuse) treatment
Pre-existing coverage and no limits:
- Pennie plans can't deny you coverage or charge you more just because you have a pre-existing condition, including mental health and substance use disorder conditions
- Coverage for treatment of all pre-existing conditions begins the day your coverage starts
- Pennie plans can't put yearly or lifetime dollar limits on coverage of any essential health benefit, including mental health and substance use disorder services
Pennie plans must provide certain parity protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.
This generally means limits applied to mental health and substance abuse services can't be more restrictive than limits applied to medical and surgical services. The limits covered by parity protections include:
- Financial - like deductibles, co-payments, co-insurance, and out-of-pocket limits\n
- Treatment - like limits to the number of days or visits covered
- Care management - like being required to get authorization of treatment before getting it