The Illinois Department of Insurance (IDOI) announced Wednesday fines totaling over $2 million for five major health insurance companies found to be in violation of the Mental Health Parity and Addiction Equity Act.
The Act is a federal law mandating that health insurance plans must have equivalent levels of coverage for mental health and substance use disorder care as for medical or surgical care; Illinois law further expanded those requirements. Market conduct examinations performed by IDOI from 2015-2017 show that CIGNA, UnitedHealthcare, HCSC (parent company of Blue Cross Blue Shield) and Celtic had multiple violations.
CIGNA Healthcare of IL paid the highest fine of $582,000 for failing to use medical necessity guidelines required by statute and the American Society of Addiction Medicine (ASAM), and not allowing providers to request an exception to the company’s step therapy requirement for prescriptions.
In 2018, IDOI successfully changed the essential health benefits of plans sold on the ACA Health Insurance Marketplace, requiring insurance companies to remove barriers for people seeking treatment for opioid use disorders. IDOI was the first state insurance department to administer targeted mental health market conduct exams for companies selling plans on the ACA Marketplace.
All five companies found to be in violation of the law have agreed to take corrective action based on the exam findings, and the Department will conduct follow up exams to ensure the companies remain in compliance.