Tip for EBSA MHPAEA Complaint

This complaint is for employer-sponsored (ERISA) plans — for individual/ACA marketplace plans, file with your state Department of Insurance or HHS

Tip for EBSA MHPAEA Complaint

Include as much documentation as possible — the more evidence you provide, the stronger your case

Tip for EBSA MHPAEA Complaint

You can also contact EBSA by phone at 1-866-444-3272 for assistance

Behavioral Healthmoderate

DOL MHPAEA Complaint Form

EBSA MHPAEA Complaint · U.S. Department of Labor (EBSA)

Complaint to DOL Employee Benefits Security Administration about employer-sponsored plan violations of mental health parity requirements under the MHPAEA.

Form Details

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Where to Submit This Form

🌐

EBSA Online Complaint Form

https://www.askebsa.dol.gov/efile/

File electronically with the Employee Benefits Security Administration.

📬

Mail to EBSA Regional Office

https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices

Send to the EBSA regional office for your area.

Filing Deadline

No specific deadline, but file promptly while evidence is fresh. ERISA plan complaints should be filed after exhausting internal plan appeals.

Required Attachments

📎 Copy of your health plan's denial letter(s)
📎 Documentation of your parity disclosure request and the insurer's response
📎 Comparison showing disparate treatment of MH/SUD vs. medical/surgical benefits
📎 Copies of your internal appeal and the appeal denial
📎 Your health plan documents (Summary Plan Description)

Processing Time

DOL investigation: 3-12 months depending on complexity. DOL may require the plan to change its practices.

What Happens Next

EBSA will investigate your complaint. They may contact your employer and health plan. If a parity violation is found, EBSA can require corrective action and retroactive claims reprocessing. You will be notified of the investigation outcome.

Tips for This Form

✓ This complaint is for employer-sponsored (ERISA) plans — for individual/ACA marketplace plans, file with your state Department of Insurance or HHS
✓ Include as much documentation as possible — the more evidence you provide, the stronger your case
✓ You can also contact EBSA by phone at 1-866-444-3272 for assistance
✓ DOL enforcement actions can benefit all plan members, not just the complainant

More Behavioral Health Forms

Mental Health Parity Disclosure Request

Parity Disclosure (insurer/state-specific) · Health Insurance Plans / State DOI

Request for insurer to disclose how it applies parity requirements: comparing treatment limits, medical necessity criteria, and non-quantitative treatment limitations (NQTLs) between mental health/substance use and medical/surgical benefits.

Mental Health Claim Appeal (with Parity Analysis)

MH Appeal Letter · Member / Attorney

Written appeal documenting how a denial violates the Mental Health Parity and Addiction Equity Act (MHPAEA). Appeals with specific parity violation documentation have significantly higher approval rates.

Substance Abuse Treatment Authorization Request

SUD PA (insurer-specific) · Health Insurance Plans

Prior authorization for inpatient detox, residential treatment, intensive outpatient (IOP), or medication-assisted treatment (MAT). Subject to MHPAEA parity requirements.

42 CFR Part 2 Substance Use Disorder Consent

42 CFR Part 2 Consent · Substance Abuse Treatment Programs

Special consent required under federal law (42 CFR Part 2) for disclosure of substance use disorder treatment records. More restrictive than standard HIPAA authorization. Requires specific elements including prohibition on re-disclosure.

Petition for Involuntary Examination

Baker Act / 5150 / Section 12 (state-specific) · State Courts / Law Enforcement / Providers

Legal petition for involuntary psychiatric examination of a person believed to meet criteria for danger to self/others or grave disability. Known by different names: Baker Act (FL), 5150 (CA), Section 12 (MA), and other state-specific designations.

Florida Baker Act Petition

Baker Act (CF-MH 3001-3100 series) · Florida Department of Children and Families

Florida-specific involuntary examination petition under the Baker Act. Allows 72-hour hold for psychiatric evaluation when a person meets criteria for involuntary examination.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the U.S. Department of Labor (EBSA) or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.