As required by § 38.2-3412.1 B of the Code of Virginia and in accordance with the federal Mental Health Parity and Addiction Equity Act of 2008, P.L. 110-343, mental health and substance use disorder benefits provided by group and individual health insurance coverage must be in parity with medical and surgical benefits coverage.

The Bureau of Insurance has developed health carrier reporting requirements for mental health and substance use disorder benefits that include denied claims, complaints, appeals, and network adequacy, and compiled the information received into this report pursuant to § 38.2-3412.1 G of the Code of Virginia. In addition, this report includes a summary of all comparative analyses of Non-Quantitative Treatment Limitations prepared by health carriers pursuant to 42 U.S.C. § 300gg-26(a)(8) and requested by the Bureau of Insurance.

To gather the necessary information, the Bureau of Insurance conducted a data call of 16 health carriers insuring more than 2.48 million lives in the individual, small group, and large group health insurance markets in Virginia during 2023. Key takeaways include: • In total, while the difference was small, carriers denied claims more often for substance use disorder benefits than for medical/surgical benefits and less often for mental health benefits. Carriers generally denied claims in fewer service categories (1 of 5) for mental health benefits and in more service categories (5 of 5) for substance use disorder benefits than claims for medical/surgical benefits.

• Denied claims involving mental health benefits were upheld by carriers in 55% of closed internal appeals and 44% of closed external reviews, compared to 61% and 51% for medical/surgical, and 77% and 67% for substance use disorder, respectively.

• The largest share of complaints differed across each benefit category. For medical/surgical benefits, claims processing accounted for 44.2% of the complaints; for mental health, administrative/service accounted for 40.9%; and for substance use disorders, utilization management accounted for 52.6%.

• Based on the data submitted by the health carriers and the existence of different standards for network adequacy, the Bureau of Insurance could not determine whether there is parity in network adequacy or compare access to network providers for mental health, substance use disorder, or medical/surgical benefits.

• The Bureau of Insurance is currently reviewing 320 comparative analyses of Non-Quantitative Treatment Limitations for this reporting period as part of the market conduct examination process. Therefore, no compliance determination has yet been made.