What to do
Work out whether a behavioral-health limitation is actually in play
Parity bites when the plan applies a mental-health or substance-use limitation. A letter requirement, a diagnosis prerequisite, or a counseling condition is often where the hook is.
Identify the limitation as non-quantitative
Prior authorization, medical-necessity criteria, network admission standards, and reimbursement rates are all non-quantitative treatment limitations, abbreviated NQTL in plan documents and regulator correspondence. Name which one you are challenging.
Request the comparative analysis in writing
Plans owe a written comparative analysis showing the limitation is applied no more stringently than to comparable medical and surgical benefits — but the duty runs to the federal Departments and to state regulators, not to you. Ask for it in writing anyway, citing the claims regulation's entitlement to the documents relied on in your claim, and if the plan refuses, the next move is a complaint to your regulator rather than a second demand. Ask for it as a document, by that name.
Read it for the comparison, not the conclusion
The analysis has to compare. An analysis that describes the behavioral-health side and never sets it beside a surgical benefit has not done the work.
Escalate the failure to produce, separately from the denial
Not producing an adequate comparative analysis is its own violation. The Department of Labor takes complaints about it for self-funded plans; state regulators for insured ones.
Get advice before you build a case on this
Parity arguments are technical and the rules are in flux. This is the point to bring in an advocacy organization or counsel.
Why the 2024 rule's status does not end the argument
The comparative-analysis obligation was not created by the 2024 rule. It was added to the parity statute itself by the Consolidated Appropriations Act, 2021, which amended the parity provisions in ERISA, the Public Health Service Act and the Internal Revenue Code.
A policy of not enforcing a 2024 RULE does not repeal a 2021 STATUTE. The regulation implementing it, 29 CFR 2590.712-1, is titled Nonquantitative treatment limitation comparative analysis requirements — read directly, so the implementing rule at least is not in doubt. The floor is lower than it was in 2024. It is not zero.
What is paused and what is not
The 2024 parity rule is under a federal non-enforcement policy tied to pending litigation, and the departments have signalled they may rescind or modify it. That is a real change and anyone telling you the 2024 requirements are being enforced is out of date.
What did not change: the 2013 rules, the statutory obligation to produce a comparative analysis on request, how to ask for it, and who can actually compel it, and your right to sue. The floor is lower than it was in 2024. It is not zero.
The honest limit of this argument
Parity is about comparison, not about whether the care is good. If a plan applies the same criteria to gender-affirming surgery that it applies to comparable surgical benefits, parity has nothing to say, however wrong the denial is on the clinical merits. Use it where the asymmetry is real and documented.
Common questions
- Is parity law still enforceable?
- The 2013 rules and the statutory comparative-analysis duty are. The newest 2024 requirements are under a federal non-enforcement policy, so do not build an argument that depends on them.
- What is a non-quantitative treatment limitation?
- A non-quantitative treatment limitation, or NQTL, is a limit that is not a number: prior authorization, medical-necessity criteria, standards for admitting providers to a network, or how reimbursement is set.
- Do I get the comparative analysis just by asking?
- Careful, because the obvious answer is too strong. The comparative-analysis duty runs to the federal Departments and to state regulators, who can demand the document. Your own route is different and usually indirect: the claims regulation entitles you to the documents and internal criteria RELEVANT TO YOUR CLAIM free of charge, which can reach the parity analysis where the plan relied on it, and a regulator can demand the whole thing. So ask, in writing, and cite the claims regulation. If the plan refuses, the next move is a complaint to your regulator, not a second demand — pushing a plan that has no direct duty to you costs weeks.
Better covered elsewhere
- National Health Law Program — parity in private plans, and your right to the plan's own analysis
Deeper than anything here on how parity arguments are actually built, and specifically on the document you are entitled to ask the plan for.
Where to go next
Sources for the legal points on this page
- Mental-health parity: the 2024 rule is paused, the older duties are not
Federal — group health plans and issuers · effective non-enforcement announced 2025-05-15
29 CFR 2590.712 and 2590.712-1 — current text still carries the 2024 rule (definitions keyed to 22 November 2024), so the rule was not rescinded. The May 2025 non-enforcement policy is sub-regulatory and was NOT located in the Federal Register, so it remains unverified
Status: contested · source-checked 2026-08-06 · primary source verified: 2026-08-06 (partial — regulation text verified, non-enforcement policy not)
Also on this page, without a citation yet
- The exact statutory subsection numbering for the comparative-analysis duty. It was added by the Consolidated Appropriations Act, 2021 amending ERISA, the PHS Act and the Internal Revenue Code; the individual subsection numbers were NOT read from the statute, because the US Code is outside the regulation database this site verifies against. The implementing regulation WAS read directly.
These are specific and checkable and we have not yet checked them against a primary source. Treat them as a starting point rather than as settled, and do not put them in an appeal without confirming them.