EQ
Equipoise

Every health plan in America has the same compliance obligation.
Almost none can meet it.

01

The Regulation

Federal law requires every health plan to prove behavioral health parity. Not aspirational. Mandatory.

The Mental Health Parity and Addiction Equity Act requires documented comparative analysis of every non-quantitative treatment limitation across every benefit classification.

Not a checklist. Not a policy statement. A six-element analytical framework applied to each NQTL, comparing mental health and substance use disorder benefits to medical/surgical benefits in writing and in operation.

Required by

Mental Health Parity and Addiction Equity Act

As amended by the Consolidated Appropriations Act, 2021

29 CFR 2590.712(c)(4)
CAA 2021 § 203
ERISA § 712(a)(8)

▸ Sources
Sources: 29 CFR § 2590.712(c)(4); Consolidated Appropriations Act, 2021, Pub. L. 116-260, § 203
02

The Failure Rate

0%

of comparative analyses submitted to the Department of Labor have been found sufficient on first review. Not one.

4

consecutive Reports to Congress

0

found sufficient

"None of the comparative analyses initially submitted were sufficient to demonstrate compliance."
— DOL EBSA, Reports to Congress 2022–2025

▸ Sources
Source: U.S. Department of Labor, EBSA Reports to Congress on MHPAEA Enforcement, 2022-2024
03

The Cost of Non-Compliance

The math is brutal.

IRC § 4980D: $100/day per affected individual

5K members
$182M / year
50K members
$1.83B / year
200K members
$7.3B / year

State Enforcement

Georgia — $25M across 22 insurers (Jan 2026)

Connecticut — Fined all 5 major insurers (Apr 2026)

Litigation

$12.9M class action settlement

Wit v. UBH — Injunction extended through 2031

▸ Sources
Sources: IRC § 4980D(b)(1); Georgia OCI Consent Orders, Jan 2026; CT Insurance Dept. Bulletin, Apr 2026; Wit v. United Behavioral Health, N.D. Cal. No. 14-cv-02346
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Why It's Failing

The analysis cannot be done manually. Not at this scale.

54+ comparison points per plan

9 NQTL categories × 6 benefit classifications

Each requires documentation of processes, strategies, evidentiary standards, and factors — for both MH/SUD and medical/surgical benefits.

And then you have to do the actual comparative analysis. Twice: as written, and in operation.

The Consulting Firm Model

Cost $150-500K
Timeline 3-6 months
DOL pass rate 0%
Shelf life Stale on delivery
▸ Sources
Sources: 29 CFR § 2590.712(c)(4)(iii)-(iv); DOL MHPAEA Self-Compliance Tool, 2024; Industry estimates; Milliman, Mercer, ATTAC engagement ranges
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Who This Is For

You already know
you have this problem.

Chief Compliance Officer
"I need documentation I can hand to the DOL tomorrow."
General Counsel
"I need a defensible analysis before a plaintiff's firm finds the gap."
VP, Behavioral Health
"I know our criteria are different. I need to quantify where."
Benefits Consultant
"My clients are asking. I need a scalable answer."
06

The Market Gap

Everyone organizes the paperwork. Nobody does the analysis.

Consulting Firms
Expensive. Manual. Point-in-time. Output still fails DOL review.
NO AUTOMATION
Workflow Platforms
Organize evidence and manage documents. Do not perform the analysis.
NO ANALYSIS
Internal Spreadsheets
Heroic effort. Inconsistent quality. Doesn't scale. Doesn't cite.
NO SCALE
The Gap
Automated comparative analysis engine. The actual analytical work. No one has built it.
UNTIL NOW
07

What If

What if the six-element comparative analysis ran automatically?
What if every NQTL was analyzed across every benefit classification in hours, not months?
What if the output cited the specific regulation and told you exactly how to fix every gap?
What if you could refresh the analysis every quarter instead of every three years?
What if it cost a fraction of what consulting firms charge?
What if you could hand the DOL a compliant analysis the day they ask for it?
08
EQ

Equipoise

Equipoise runs the DOL's six-element comparative analysis across every NQTL and benefit classification — and delivers documentation-ready output with regulatory citations and remediation recommendations.

Step 1
You provide plan data
UM policies, BH criteria, formulary rules, network standards
→
Step 2
Equipoise runs the six-element analysis
Every NQTL, every benefit classification, both as written and in operation
→
Step 3
You receive documentation-ready output
Citations, severity assessments, and specific remediation. Hours, not months.
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Sample Output

What the analysis produces.

NQTL
Prior Authorization — Concurrent Review
Benefit Classification
Outpatient In-Network
Finding
MH/SUD concurrent review requires clinical documentation every 3 visits; medical/surgical concurrent review triggered only at 12+ visit threshold. Review frequency for MH/SUD is 4x more stringent as written. 29 CFR § 2590.712(c)(4)(iii)(A)
Severity
HIGH
Remediation
Align MH/SUD concurrent review frequency to medical/surgical threshold (12-visit trigger) or provide documented, evidence-based clinical rationale for differential frequency per 29 CFR § 2590.712(c)(4)(iv).
▸ See all six elements
Element 1

Processes

How the NQTL is applied in practice

Element 2

Strategies

The rationale and goals behind the limitation

Element 3

Evidentiary Standards

Evidence required for decision-making

Element 4

Factors

Sources and considerations used in design

Element 5

Comparability — As Written

Do the terms of the NQTL apply comparably?

Element 6

Comparability — In Operation

Does the NQTL function comparably in practice?

▸ Sources
Source: 29 CFR § 2590.712(c)(4)(iii)(A)-(B); DOL Self-Compliance Tool for the MHPAEA Comparative Analysis, 2024
10

The Window

Every month without a compliant analysis is a month of accumulating exposure.

Jan 2026
Georgia fines 22 insurers $25M total for parity violations
Apr 2026
Connecticut fines all 5 major insurers operating in state
Ongoing
DOL continues reviewing analyses under existing law regardless of the 2024 Rule pause
Pending
Parity Enforcement Act of 2025 (H.R. 957) would add civil monetary penalties to ERISA enforcement
Ongoing
Delaware, Washington, and additional states initiating enforcement actions

The question is not whether your plan will be reviewed.
It's whether your analysis is ready when it is.

▸ Sources
Sources: Georgia OCI Enforcement Actions, Jan 2026; CT Insurance Dept., Apr 2026; H.R. 957, 119th Congress; DOL EBSA enforcement updates, 2024-2025
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EQ

The analysis your plan is required to maintain. Automated.

Live. Accepting design partners →

First analysis delivered within 48 hours. Design partners receive priority access.

Request access under NDA →

Built by healthcare operations leaders with direct experience in utilization management, behavioral health program design, and parity compliance.

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