(1)

The Advisory Council on Employee Welfare and Pension Benefit Plans (ERISA Advisory Council) was established pursuant to section 512 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1142) to provide advice and recommendations to the Secretary of Labor.

(2)

In 2023, the ERISA Advisory Council published a report to the Secretary entitled Long-Term Disability Benefits and Mental Health Disparity.

(3)

This report found that discriminatory benefit limitations—including duration limits found in nearly all long-term disability benefit plans—impede access to disability benefits for workers whose disability is caused by a behavioral health condition.

(4)

The report called for the Secretary to work with Congress to ensure that there is parity in disability benefits provided to workers.

(1)

benefit limitations for workers whose disability is caused by a behavioral health condition are discriminatory; and

(2)

disability benefits should be provided without regard to the cause of a worker’s disability.

(a) In general

Subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1021 et seq.) is amended by adding at the end the following new part:

9 Disability benefit plan requirements

901. Definitions

For purposes of this part:

(1) Disability benefit

The term disability benefit means payment provided to a participant or beneficiary as a result of the loss of earning capacity resulting from injury or sickness.

(2) Disability benefit plan

The term disability benefit plan means an employee welfare benefit plan that provides a disability benefit to participants or beneficiaries directly or through insurance or otherwise.

(3) Mental health condition

The term mental health condition means any condition (other than a substance use disorder) that falls under any of the diagnostic categories listed in the mental, behavioral, and neurodevelopmental disorders chapter (or equivalent chapter) of the current version of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (or a successor publication), or that is listed in the current version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (or a successor publication).

(4) Substance use disorder

The term ‘substance use disorder’ means any disorder that falls under any of the diagnostic categories listed as a mental or behavioral disorder due to psychoactive substance use (or equivalent category) in the mental, behavioral, and neurodevelopmental disorders chapter of the current version of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (or a successor publication) or that is listed as a Substance-Related and Addictive Disorder (or equivalent category) in the current version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (or a successor publication).

902. Parity requirement for disability benefits

A disability benefit plan—

(1)

may not place a limitation, exclusion, or other restriction on benefits relating to a disability arising from a mental health condition or substance use disorder that is more restrictive than those applicable to benefits relating to a disability arising from a physical health condition; and

(2)

shall consider any physical health condition suffered by an individual that is caused by a disability arising from a mental health condition or a substance use disorder to be part of such disability.

(b) Civil monetary penalties

Section 502(c) of such Act is amended by adding at the end the following:

(13) Civil penalties for violations of Part 9

(A) In general

The Secretary may assess a civil penalty against any sponsor, administrator, service provider, or any other person or entity (except for a plan) who violates, or knowingly causes or conceals a violation of, part 9 of this title.

(B) Amount

The amount of the penalty imposed by subparagraph (A) shall be equal to the amount of the penalty described in paragraph (10)(B) for each day in the noncompliance period described in subparagraph (C) with respect to each participant or beneficiary to whom such violation relates.

(C) Noncompliance period

In this paragraph, the term noncompliance period means, with respect to a violation described in subparagraph (A), the period—

(i)

beginning on the date the violation occurs; and

(ii)

ending on the date the violation is corrected.

(1) Administrator

The term administrator has the meaning given the term in section 3(16)(A) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002(16)(A)).

(2) Employer

The term employer has the meaning given the term in section 3(5) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002(5)).

(3) Governmental employee benefit plan

The term governmental employee benefit plan has the meaning given governmental plan in section 3(32) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002(32)), except that such term shall not include a plan established or maintained for its employees by the Government of the United States, or any agency or instrumentality thereof.

(4) Issuer

The term issuer means an insurance company, insurance service, or insurance organization, which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of section 514(b)(2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)(2))). Such term does not include an employee benefit plan (as defined under section 3(3) of such Act (29 U.S.C. 1002(3))).

(5) Secretary

The term Secretary means the Secretary of Labor.

(6) State

The term State includes—

(7) Additional ERISA terms

The terms disability benefit, disability benefit plan, mental health condition, and substance use disorder have the meanings given the terms in section 901 of the Employee Retirement Income Security Act.

(8) Other ERISA terms

The terms administrator, employer, and State have the meanings given the terms in section 3 of such Act.

(1)

may not place a limitation, exclusion, or other restriction on benefits relating to a disability arising from a mental health condition or substance use disorder that is more restrictive than those applicable to benefits relating to a disability arising from a physical health condition; and

(2)

shall consider any physical health condition suffered by an individual that is caused by a disability arising from a mental health condition or a substance use disorder to be part of such disability.

(a) State enforcement

(b) Secretarial enforcement authority

(c) Right of action

Any individual who is aggrieved by the failure of a governmental employee benefit plan or issuer, with respect to disability benefits, to comply with the requirements of this title may bring an action in State or Federal court for appropriate equitable relief.

(a) Study

Not later than 18 months after the date of enactment of the Worker’s Disability Benefits Parity Act of 2025, the Secretary shall carry out a study on the cost to plan sponsors of providing disability benefits to participants and beneficiaries whose disability is caused by a behavioral health condition, including an actuarial analysis of such cost.

(b) Education

Not later than 18 months after the date of enactment of the Worker’s Disability Benefits Parity Act of 2025, the Secretary shall conduct outreach and provide information to plan sponsors on the effect of duration limits on access to benefits by participants and beneficiaries with mental health and substance use disorder conditions.

(a) In general

The amendments made by this Act shall apply to plan years that begin after the date that is 18 months after the date of enactment of this Act.

(b) Special rule for collective bargaining agreements

In the case of a plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act, the amendments made by this section shall not apply to plan years beginning before the later of—

For purposes of paragraph (1), any plan amendment made pursuant to a collective bargaining agreement relating to the plan that amends the plan solely to conform to any requirement added by this section shall not be treated as a termination of such collective bargaining agreement.