Eileen submits a claim for clinical depression under her employer-sponsored health plan. Benefits for this condition are:

• A. Not covered
• B. Covered with a separate deductible
• C. The same as benefits for physical illness and injury
• D. Covered only when medically necessary

Answer: (C)

Mental health benefits are designed to be on par with medical/surgical benefits in many employer-sponsored plans. This parity means the terms of coverage—such as deductibles, coinsurance or copays, and any visit or treatment limits—apply the same to depression as they do to physical illnesses or injuries. So if physical health care in the plan shares a certain deductible and cost share, depression treatment should have the same financial terms and limits. Medical necessity can still determine whether a specific service is covered, but the overall level of benefits is intended to be equal for mental and physical health. That’s why the best choice is that benefits for this condition are the same as benefits for physical illness and injury. The other options imply special treatment (a separate deductible, or not covered, or only covered under a stricter medical-necessity rule), which parity rules generally avoid.