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Timothy's
Law
New York State's Mental Health Parity Law
Timothy's
Law is named after Timothy O'Clair, a 12-year old boy with
a serious emotional disturbance who completed suicide a
few months before his 13th birthday. Tom and Donna O'Clair,
Timothy's parents, were forced to give up custody of their
son in order to ensure his access to necessary mental health
services. The health insurance coverage that Tom O'Clair
received through his job was considered adequate, but like
so many insurance plans, it did not provide sufficient coverage
for mental health treatment. Tom and Donna O'Clair believe
that Timothy would still be alive today if they had been
able to retain custody of their child and oversee his treatment.
As a result of their experience, they vowed that other families
would not be forced to make the same heartbreaking choice.
New Yorkers owe an enormous amount of gratitude to the O'Clairs
for their tireless advocacy efforts on this issue.
Summary
of Timothy's Law
Part I: Base Benefit (for all fully-insured companies regardless
of size)
The base benefit under Timothy's Law requires all fully-insured
businesses to provide a minimum of 20 outpatient mental
health days and 30 inpatient mental health days (referred
to as the 20/30 base benefit) with co-payment and deductible
rates equal to that of the original health insurance plan.
The diagnoses that are covered are equal to that of the
Empire Plan for NY State employees, which covers the majority
of the diagnosis categories listed in the DSM-IV (Diagnostic
and Statistical Manual of Mental Disorders).
Part
II: Expanded Benefit (mandatory for companies with >
50 employees)
For fully-insured businesses with more than 50 employees,
employers are required to provide unlimited mental health
coverage for biologically-based mental illnesses, which
are defined as schizophrenia/psychotic disorders, major
depression, bipolar disorder, delusional disorders, panic
disorder, obsessive compulsive disorders, anorexia, and
bulimia.
What
will it cost your business?
If your company has 50 employees or fewer, the base benefit
will be added at NO additional cost! In addition, you will
have the option to buy-into full parity. Timothy's Law contains
a hold harmless provision for small businesses that instructs
the superintendent of insurance to develop a methodology
to cover the costs that small businesses incur when increasing
coverage to meet the 20/30 minimum. (Note: Timothy's Law
defines small businesses as having 50 or fewer employees)
Who
is exempt from Timothy's Law?
Timothy's Law does is not applicable to self-insured companies,
due to an exemption through Employee Retirement Income Security
Act (ERISA), Health NY, Family Health Plus, & Child
Health Plus.
Timothy's
Law Campaign: What's next?
Information about new legislation coming soon…
For
more information, visit the Timothy's
Law Campaign web site.
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