I would review access, cost-sharing, substance use treatment and the handoff from an employee assistance program. Federal parity requirements remain important, although the agencies announced nonenforcement of the 2024 final rule while reconsidering it. That announcement did not suspend the underlying statute or the earlier rules.
The short version
- Check access
- Available appointments, not directory size
- Parity law
- MHPAEA
- EAP
- Check session limits and referrals
- Compare
- Annual costs and treatment access
How many people on your plan need mental health care
SAMHSA’s national survey documents substantial mental health and substance use needs. But a national prevalence estimate does not establish how many people on a particular team need care. I would plan for confidential access without asking managers to identify who might use it.
Review employees and dependents separately. A network that serves adults may not include a clinician accepting children, and a telehealth service may not offer every level of treatment. Ask the administrator to demonstrate the route from an initial request to an appointment and, if necessary, a higher level of care.
What good coverage looks like
| Service | What good looks like | Common gap |
|---|---|---|
| Outpatient therapy | Low copay from the first session, no visit cap | Full cost until a high deductible is met |
| Psychiatry and medication management | In-network psychiatrists or psychiatric nurse practitioners with openings within weeks | Long waits, many psychiatrists out of network |
| Telehealth | Video therapy and psychiatry covered like in-person visits | Telehealth limited to one vendor's network |
| Intensive outpatient and partial hospitalization | Covered with the same rules as comparable medical care | Stricter prior authorization than medical |
| Inpatient and residential treatment | Covered for mental health and substance use, with clear medical necessity criteria | Blanket exclusions of residential care |
| Substance use treatment | Medications for opioid use disorder, outpatient and inpatient care | Fail-first rules not used for medical drugs |
| Crisis care | Emergency and crisis services covered like any emergency | Ask how emergency billing protections and the policy apply to the particular facility |
An employee assistance program (EAP) is a useful front door: a few free, confidential sessions and referrals. It is not a substitute for therapy coverage in the health plan. Many people need more sessions than an EAP provides, and the handoff is where they drop out.
The real problem is the network
A provider directory is a starting point, not proof of access. For each location where employees live, ask the administrator to confirm participation in the exact plan, acceptance of new patients, appointment availability and the types of patients treated. Repeat the check for therapy, medication management and substance use services. Let employees make private checks for their own clinicians rather than collecting treatment histories at work.
When people can't find in-network care, they pay cash, rely on out-of-network reimbursement, or give up. Ask any carrier or vendor for the share of in-network therapists accepting new patients and the median wait for a first appointment, not just the size of the directory.
What a year of weekly therapy costs an employee
What parity law requires
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans that cover mental health and substance use disorder benefits to do so on terms no more restrictive than medical and surgical benefits. That covers financial rules (copays, deductibles, coinsurance), numeric limits (visit or day caps), and non-numeric rules called nonquantitative treatment limitations or NQTLs: prior authorization, medical necessity criteria, step therapy, network admission standards and how out-of-network rates are set. Financial requirements and quantitative limits are tested within benefit classifications using substantially-all and predominant-level rules. Comparing one therapy visit with one medical visit is not a complete compliance analysis.
| Plan rule | Allowed? |
|---|---|
| $30 copay for therapy when primary care visits cost $30 | Not enough information: the financial requirement must satisfy the applicable classification test, not simply match a primary care copay |
| 20 therapy visits a year when medical office visits are unlimited | No: a numeric limit applied only to mental health |
| Prior authorization for every therapy visit but not for comparable medical visits | Likely no: a stricter NQTL |
| Excluding residential treatment for addiction while covering skilled nursing for medical conditions | Regulators treat blanket exclusions like this as an enforcement priority |
| Not covering mental health at all | Only for plans not required to cover it (see below) |
Which plans it applies to. Insured small group and individual plans must cover mental health and substance use services as an essential health benefit, and HHS rules require that coverage to meet parity. Large group plans that cover these services must follow parity. MHPAEA has a small employer exemption for employers with 50 or fewer employees, which in practice matters mostly for small self-funded plans; insured small group plans are pulled back in through the EHB rules. Since 2021, the Consolidated Appropriations Act has required plans to document a written comparative analysis showing their NQTLs meet parity and to produce it on request.
The 2024 parity rule: where enforcement stands in 2026
The Departments’ May 15, 2025 statement says they will not enforce the 2024 final rule for failures occurring before a final decision in the litigation, plus 18 months. It also says the agencies will reconsider the rule. I would not treat an anticipated replacement rule or an unverified timeline as an obligation already in force.
The statement preserves the statutory MHPAEA obligations, the 2013 regulations and the comparative-analysis requirements added by the Consolidated Appropriations Act, 2021. For a plan subject to those requirements, ask who prepares the analysis, how it is updated and how the administrator will respond to a participant or regulator request. Hiring an administrator does not remove the sponsor’s applicable duties.
DOL’s September 8, 2026 Field Assistance Bulletin 2026-03 confirms the continuing nonenforcement of provisions new in the 2024 rule and identifies three NQTL priorities: separate treatment limitations and exclusions, medical-necessity review, and network standards including admission and reimbursement methods. This is an enforcement policy, not a repeal of statutory parity duties.
Loneliness is a health issue
The Surgeon General’s 2023 advisory identifies social connection as a public health concern. The associations it summarizes do not prove that an employer social event prevents a specific illness. My practical suggestion is to make participation in workplace activities optional, respect different needs, and keep social support separate from access to clinical treatment.
What an employer can do this year
- Price therapy under your plan the way the example above does. If a year of weekly sessions costs more than a couple of thousand dollars in network, fix plan design first.
- Test the network: ask for the number of in-network therapists and psychiatrists near your team who are accepting new patients, and the typical wait.
- Make telehealth therapy and psychiatry part of the plan, not only an add-on.
- Tell employees how to get care in plain language: who to call, what it costs, and how clinical information is protected. Put the 988 Suicide and Crisis Lifeline in your benefits guide; call 911 for immediate physical danger or a medical emergency.
- Ask your carrier or administrator for the parity comparative analysis, especially if you're level-funded.
- Train managers to point people to resources, not to diagnose.
Check the handoff when short-term support ends
I would ask the EAP and medical plan to describe one ordinary handoff: a member completes the sessions included in the EAP and needs continuing therapy. Who finds the next clinician? Can the employee keep the same therapist under the medical benefit? Is a new authorization needed, and what will the next visit cost? Request a written explanation that employees can use without telling a manager why they need it.
For children and adolescents, confirm age eligibility and the availability of appropriate clinicians. A platform offering adult video visits does not necessarily provide pediatric psychiatry or family therapy. For substance use care, ask how members locate the needed level of treatment and how the plan handles a transition between inpatient and outpatient services. These are access questions, not an instruction for managers to choose treatment.
If the directory fails, ask the administrator to help locate an available provider and explain any network-exception process. Keep records of the access problem without circulating clinical information at work. The plan’s denial and appeal procedures should be easy to find.
How Prescience helps
At Prescience, we design and run your company's health plan, from setup and enrollment to claims, compliance and COBRA. What your team gets:
- An effective $0 deductible, so the plan helps from the first visit.
- Simple copays shown before a visit, capped by a low out-of-pocket maximum.
- A broad national PPO network, plus providers we contract with directly.
- 24/7 physician-led care navigation: a care team that finds the right provider, books appointments and explains costs up front.
What your company gets: one monthly cost set in your quote, usually 10–20% below comparable fully insured coverage and fixed before the plan starts, with no admin fees. You keep your payroll provider, and the plan can start mid-year.
