The United States Department of Labor recently concluded a standard, random audit of Marquette’s medical plan for the years 2012–17. After reviewing the plan and regulatory changes over that timeframe, the audit revealed one anomaly within the plan — this email serves as a university-wide notification of that finding.
In 2010, Congress expanded the Mental Health Parity Act to include a provision, which states that medical and behavioral health benefits must be offered equally. To comply with this regulation, Marquette changed its behavioral health benefits to match its medical benefits: An eligible participant in the plan seeking behavioral health services could receive his or her first 24 visits without medical necessity. Upon the 25th visit, the participant would be required to secure documented medical necessity to continue covered treatment.
The DOL has determined that — although Marquette made a good faith effort to achieve parity in its coverage — the coverage was too restrictive, and the 24-visit cap should have been eliminated altogether for both medical and behavioral health coverage.
Marquette has since updated its plan document to reflect this clarification by the DOL. Further, the university has reprocessed more than 174 claims with this modification and has made the proper financial adjustments according to plan provisions.
If you feel that you may have fallen into this category during the 2012–17 timeframe, please email Steve McCauley, director of employee benefits, and include the following information:
- Date range of service(s)
- Type of service(s)
Once this information is received, the Benefits Department will work with UMR, the university’s third-party administrator, in accessing your claim. Due to the nuances of the various claims, we will work to be as timely as possible in expediting your request. Upon the conclusion of the department’s research, you will be notified of the findings and whether there any additional action is required.
Please contact McCauley with questions.