Lawsky Enforces Mental Health Coverage Law with $2.7M in Fines

“Mental illness can have devastating consequences for families. It’s essential that people understand that insurance benefits are available for treating mental illnesses and that businesses know this option is available,” DFS Superintendent Benjamin Lawsky said.

“We are very pleased that the Department of Financial Services has taken our concerns seriously,” stated  Shelly Nortz, deputy executive director with Coalition for the Homeless and Steering Committee and a member of the Timothy’s Law Campaign.

Under Timothy’s Law, insurance plans – for both large and small employer groups – are required to provide 30 days of inpatient treatment and 20 days of outpatient visits for mental health treatment.

Large group plans with more than 50 employees are mandated to provide coverage for treating biologically based mental illnesses and children with serious emotional disturbances at a level that is comparable to coverage for non-mental health conditions.

The law requires insurers to offer small groups the option of buying this level of comparable coverage as an extended benefit. Small groups are those with fewer than 50 employees. The DFS investigation found that the violations occurred during calendar years 2009 and 2010. In addition to the insurers fined, Department examiners also polled additional insurance companies, but those companies were not found to have failed to provide the required written notifications.

Timothy’s Law is named for Timothy O’Clair, a 12-year-old boy from Schenectady County who took his own life in 2001 when his family was unable to obtain adequate mental health treatment for him. O’Clair had struiggled with severe emotional and behavioral problems throughout his short life.