MHPAEA Comparative Analysis (NQTL)

Plans covering both medical/surgical and mental-health or substance-use benefits must document a written comparative analysis showing every nonquantitative treatment limitation is no more restrictive for MH/SUD benefits. There's no filing; you produce it to regulators on request.

See the Step-by-Step ProcessView Templates & Resources
Heads up, what's in force vs. paused (2026): The statutory requirement to perform and document an NQTL comparative analysis has been in effect since February 2021 and is still actively enforced. A separate 2024 final rule added new, more detailed content and procedural requirements (applicable for plan years beginning in 2025 and 2026). In May 2025 the Departments announced they will not enforce those new 2024-rule provisions while litigation (the ERIC lawsuit) is resolved, plus 18 months after. Do not read this as "parity is on hold"; the underlying comparative-analysis obligation remains, and DOL continues to request analyses.
What A written, NQTL-by-NQTL comparative analysis demonstrating that nonquantitative limits on MH/SUD benefits are comparable to, and applied no more stringently than, those on medical/surgical benefits, both as written and in operation. This is distinct from the participant-facing MHPAEA notice (see the MHPAEA Notice page).
Who Group health plans (and insurers) that provide both medical/surgical and MH/SUD benefits. Self-funded plans of employers with 51+ employees, and fully-insured large- and small-group plans, are in scope. Self-funded plans of small employers (50 or fewer employees), retiree-only plans, and excepted benefits are generally exempt from MHPAEA.
When No annual filing. The analysis must exist, be kept current, and be furnished on request to the DOL, HHS, or a state regulator. Review and update it whenever plan terms, vendors, or NQTLs change. Self-funded: the plan sponsor is responsible (a TPA or vendor usually compiles it). Fully-insured: the carrier typically drafts it; confirm it exists.
Risk No fixed dollar-penalty schedule for the analysis itself, but a deficient or missing analysis can trigger a DOL corrective-action process, required participant notification of noncompliance, excise tax exposure under IRC Section 4980D ($100/day per affected individual), and follow-up federal scrutiny. MH/SUD parity is a stated DOL enforcement priority.
On request
Produced to regulators

The analysis must already exist and be furnished within the time stated in the request.

Annual
Review (best practice)

Not legally required on a fixed date, but reviewing each plan year keeps it request-ready.

Since 2021
In force

The statutory comparative-analysis requirement has been enforced since February 2021.

Trigger Timing Who Acts Notes
DOL / HHS / state request for the analysis On demand; respond within the time stated in the request (historically a short window) Plan sponsor (with carrier/TPA) The analysis must already exist when requested; it cannot be built from scratch after the letter arrives without risking a deficiency finding.
Plan, vendor, or NQTL change When the change takes effect Plan sponsor New utilization-management rules, network standards, formulary changes, or a TPA switch all warrant updating the analysis.
Annual review (best practice) Each plan year Plan sponsor Not legally required on a fixed date, but reviewing alongside other annual compliance keeps the analysis current and request-ready.
Trigger: DOL / HHS / state request
Timing: On demand, within the stated window
Notes: Must already exist when requested; can't be built after the letter arrives.
Trigger: Plan, vendor, or NQTL change
Timing: When the change takes effect
Notes: New UM rules, network standards, formulary changes, or a TPA switch warrant an update.
Trigger: Annual review (best practice)
Timing: Each plan year
Notes: Keeps the analysis current and request-ready.
  • Plan documents and SPD: The terms describing MH/SUD and medical/surgical benefits, exclusions, and any treatment limitations.
  • List of NQTLs: Every nonquantitative limit applied to benefits: prior authorization, concurrent/retrospective review, step therapy/fail-first, medical-necessity and level-of-care criteria, network admission and credentialing standards, provider reimbursement methodology, formulary design, and out-of-network rules.
  • The "as written" terms for each NQTL in both classifications (MH/SUD vs. med/surg) so they can be compared.
  • The "in operation" evidence: Data and processes showing how each NQTL is actually applied: denial/approval rates, authorization timeframes, criteria sources, and the factors and evidentiary standards used to design the limit. This is where most analyses fall short.
  • Six classifications mapping: Inpatient in-network, inpatient out-of-network, outpatient in-network, outpatient out-of-network, emergency care, and prescription drugs; each NQTL is compared within a classification.
  • Vendor contacts: Carrier, TPA, PBM, behavioral-health/utilization-management vendor, and any parity-analysis consultant.
1
Confirm who is preparing it
  • Fully-insured: Ask your carrier to provide the comparative analysis for your plan. Get it in writing and keep a copy; you may be asked to produce it.
  • Self-funded / level-funded: Engage your TPA, behavioral-health vendor, and (commonly) a parity consultant or benefits counsel to build the analysis. The plan sponsor stays responsible.
2
Inventory your NQTLs by classificationList each nonquantitative limit and the benefit classification(s) it applies to across the six classifications above.
3
Document the analysis for each NQTLFor every NQTL, capture the required elements: a description of the limit and the benefits affected; the factors used to design it; the evidentiary standards and other sources relied on; the comparability of those factors as written; and the comparability as applied in operation. Identify the responsible parties.
4
Find and fix outliersIf MH/SUD limits are more stringent in design or operation than comparable med/surg limits, work with the vendor to correct the plan provision or administration before a regulator asks.
5
Assemble the request-ready packageKeep the full written analysis, supporting data, and vendor attestations together so the plan can respond promptly to a DOL/HHS/state request.
6
Schedule a refreshRe-review when the plan, vendor, or any NQTL changes, and at least annually as a best practice.
  • Federal regulators: The DOL (for ERISA plans), HHS, or Treasury may request the analysis. Respond within the timeframe stated in the request.
  • State regulators: For fully-insured plans, the state insurance department may request it; coordinate with the carrier.
  • Participants and authorized representatives: On request, plans must generally make MHPAEA information, including the criteria for medical-necessity determinations and the reason for any MH/SUD benefit denial, available to participants and beneficiaries.
  • No routine submission: Unlike Form 5500 or RxDC, nothing is filed on a schedule. The obligation is to have the analysis and produce it when asked.
  • The complete written comparative analysisFor each plan year, covering every NQTL.
  • The supporting data and processesBehind the "in operation" comparisons (denial rates, authorization data, criteria sources).
  • Carrier/TPA/vendor attestationsConfirming who prepared the analysis and that it is current.
  • Regulator correspondenceAny correspondence with regulators and your responses, plus records of corrective actions taken.
  • RetentionRetain records at least 7 years, consistent with ERISA document-retention practices and audit lookback periods.

Common traps

Treating the 2025 enforcement pause as repeal: The pause applies only to the new 2024-rule provisions. The statutory comparative-analysis requirement (in effect since 2021) is still enforced, and DOL still requests analyses.
"As written" only: A common deficiency is documenting the plan language but not the in-operation data showing how the NQTL is actually applied. Both are required.
Assuming the carrier or TPA automatically has a plan-specific analysis: Many provide a generic template, not one tailored to your plan. Confirm it's specific and request-ready.
Self-funded plan sponsors assuming delegation transfers liability: The TPA can build it, but the plan sponsor remains responsible for producing a compliant analysis.

FAQs

What is an NQTL?

A nonquantitative treatment limitation is a non-numerical limit on the scope or duration of benefits, for example prior authorization, step therapy, medical-necessity criteria, network admission standards, and how provider reimbursement rates are set. (Numerical limits like copays and visit caps are quantitative limits, handled separately.)

We're a small employer, does this apply?

A self-funded plan of an employer with 50 or fewer employees is generally exempt from MHPAEA. Fully-insured small-group plans must still meet parity through the ACA's essential-health-benefit rules, and the carrier handles compliance. Confirm your size and funding before concluding you're exempt.

We're fully-insured, do we need to do anything?

Ask your carrier to provide the comparative analysis for your plan and keep a copy. The carrier typically prepares it, but the plan should be able to produce it if asked.

Is there a form to file?

No. There is no annual form or filing. You must maintain the written analysis and furnish it to regulators (and certain information to participants) on request.

What happens if our analysis is found deficient?

The Departments give the plan a chance to correct it, then re-review; unresolved noncompliance can require notifying participants that the plan is not in compliance and can expose the plan to enforcement and excise-tax liability under IRC Section 4980D.

  • Fully-insured vs. self-funded: For fully-insured plans the carrier generally builds and stands behind the analysis; for self-funded and level-funded plans the plan sponsor is responsible and typically relies on the TPA plus a parity vendor.
  • Small self-funded employers (50 or fewer employees): Generally exempt from MHPAEA. Fully-insured small-group plans get parity through ACA essential-health-benefit rules instead, with the carrier responsible.
  • Retiree-only and excepted-benefit plans: Retiree-only plans and excepted benefits (stand-alone dental/vision, most EAPs) are outside MHPAEA's scope.
  • Carve-out behavioral-health vendors: When MH/SUD is managed by a separate vendor, that vendor's NQTLs (utilization management, network standards, reimbursement) must be included in the analysis and coordinated with the medical carrier/TPA.
  • 2024 final rule status: The 2024 rule's new content and procedural requirements apply for plan years beginning in 2025 and 2026 but are under a federal non-enforcement policy pending the ERIC litigation plus 18 months. Watch for the litigation's resolution or a revised/rescinded rule, which would change what's required going forward.

There's no government form to file. The most useful tool is DOL's Self-Compliance Tool, which walks through each NQTL; use it to build or pressure-test your analysis, and use the drop-in request below to get the analysis from your carrier or TPA.

Request to carrier / TPA (drop-in language): Send to the entity that administers your MH/SUD benefits.

"Please provide the written NQTL comparative analysis for our plan as required under MHPAEA and the Consolidated Appropriations Act, 2021. We need a plan-specific analysis (not a generic template) that documents, for each nonquantitative treatment limitation, the factors and evidentiary standards used and the comparability of those limitations to medical/surgical benefits both as written and in operation, so the plan can produce it on request from the DOL, HHS, or a state regulator. Please also confirm who prepared it and the date it was last updated."