United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2002-02-28 monographic deposited born digital 32 p. GA 1.13:GAO-02-339 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-02-339 P0b002ee18037556e f:d02339 DGPO 2010-08-12 2011-03-23 GAOREPORTS-GAO-02-339 machine generated eng fdlp REPORT GAOREPORTS-GAO-02-339 GAO-02-339 Health insurance Insurance premiums Insurance regulation Mental illnesses Other Written Product A02819

Five percent of adults suffer from serious mental disorders. Although health insurance carriers in a few states guarantee coverage for mental health treatment, in most states individuals with mental disorders may face restrictions in purchasing health insurance for themselves and their families in the individual insurance market. Eleven states require carriers to accept all applicants regardless of health status, but coverage options vary. Eight of these 11 states require all carriers to guarantee access to coverage sold in this market. In three states, laws apply only to some carriers, such as Blue Cross and Blue Shield, or certain periods of the year. Carriers in nine of the 11 states are also required to limit the extent to which premium rates vary between healthy and unhealthy individuals. In states without guaranteed coverage in the individual market, the seven carriers GAO reviewed would likely deny coverage more frequently for applicants with mental disorders than for applicants with other chronic health conditions. Specifically, for six mental disorders of generally moderate severity, carriers said that they would likely decline applicants 52 percent of the time. State-sponsored high-risk pools are the primary coverage option available to rejected applicants in most states. In 27 of the 34 states where carriers may deny coverage to applicants with mental disorders or other health conditions, high-risk pools offer coverage to applicants denied individual market coverage. The pools are subsidized--generally through assessments on carriers or state tax revenues--and premium rates are generally capped at 125 to 200 percent of standard rates for healthy individuals. Health benefits available under the pools are generally comparable to those available in the individual market, including similar restrictions on mental health benefits; however, benefits for mental disorders or other health conditions are not permanently excluded as they may be in the individual insurance market. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-02-339/html/GAOREPORTS-GAO-02-339.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-02-339/pdf/GAOREPORTS-GAO-02-339.pdf GAO-02-339 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-02-339 Other Written Product GAO-02-339; Private Health Insurance: Access to Individual Market Coverage May Be Restricted for Applicants with Mental Disorders; Health insurance Insurance premiums Insurance regulation Mental illnesses Title 29 Section 1161 Title 29 Section 1185a 29 U.S.C. 1161 29 U.S.C. 1185a Volume 110 Page 1936 Volume 110 Page 2847 110 Stat. 1936 110 Stat. 2847 Public Law 104-191 Public Law 104-204