(or health insurance coverage offered in connec-
tion with such a plan) that provides any mental 
health and substance-related disorder benefits, 
the plan or coverage shall include benefits for 
any mental health condition or substance-re-
lated disorder for which benefits are provided 
under the benefit plan option offered under 
chapter 89 of title 5, United States Code, with 
the highest average enrollment as of the begin-
ning of the most recent year beginning on or 
before the beginning of the plan year involved. 
‘‘(B) EQUITY
IN
COVERAGE
OF
OUT-OF- 
NETWORK BENEFITS.— 
‘‘(i) IN GENERAL.—In the case of a 
plan or coverage that provides both med-
ical and surgical benefits and mental 
health and substance-related disorder bene-
fits, if medical and surgical benefits are 
provided for substantially all items and 
services in a category specified in clause 
(ii) furnished outside any network of pro-
viders established or recognized under such 
plan or coverage, the mental health and 
substance-related disorder benefits shall 
also be provided for items and services in 
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such category furnished outside any net-
work of providers established or recognized 
under such plan or coverage in accordance 
with the requirements of this section. 
‘‘(ii) CATEGORIES
OF
ITEMS
AND 
SERVICES.—For purposes of clause (i), 
there shall be the following three categories 
of items and services for benefits, whether 
medical and surgical benefits or mental 
health and substance-related disorder bene-
fits, and all medical and surgical benefits 
and all mental health and substance-re-
lated disorder benefits shall be classified 
into one of the following categories: 
‘‘(I) EMERGENCY.—Items and 
services, whether furnished on an in-
patient or outpatient basis, required 
for the treatment of an emergency 
medical condition (including an emer-
gency condition relating to mental 
health 
and 
substance-related 
dis-
orders). 
‘‘(II) 
INPATIENT.—Items 
and 
services not described in subclause (I) 
furnished on an inpatient basis. 
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‘‘(III) OUTPATIENT.—Items and 
services not described in subclause (I) 
furnished on an outpatient basis.’’. 
(e) REVISION OF INCREASED COST EXEMPTION.— 
Paragraph (2) of subsection (c) of such section is amended 
to read as follows: 
‘‘(2) INCREASED COST EXEMPTION.— 
‘‘(A) IN
GENERAL.—With respect to a 
group health plan (or health insurance coverage 
offered in connection with such a plan), if the 
application of this section to such plan (or cov-
erage) results in an increase for the plan year 
involved of the actual total costs of coverage 
with respect to medical and surgical benefits 
and mental health and substance-related dis-
order benefits under the plan (as determined 
and certified under subparagraph (C)) by an 
amount that exceeds the applicable percentage 
described in subparagraph (B) of the actual 
total plan costs, the provisions of this section 
shall not apply to such plan (or coverage) dur-
ing the following plan year, and such exemption 
shall apply to the plan (or coverage) for 1 plan 
year. 
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‘‘(B) APPLICABLE PERCENTAGE.—With re-
spect to a plan (or coverage), the applicable 
percentage described in this paragraph shall 
be— 
‘‘(i) 2 percent in the case of the first 
plan year which begins after the date of 
the enactment of the Paul Wellstone Men-
tal Health and Addiction Equity Act of 
2007; and 
‘‘(ii) 1 percent in the case of each 
subsequent plan year. 
‘‘(C) DETERMINATIONS BY ACTUARIES.— 
Determinations as to increases in actual costs 
under a plan (or coverage) for purposes of this 
subsection shall be made by a qualified actuary 
who is a member in good standing of the Amer-
ican Academy of Actuaries. Such determina-
tions shall be certified by the actuary and be 
made available to the general public. 
‘‘(D) 6-MONTH
DETERMINATIONS.—If a 
group health plan (or a health insurance issuer 
offering coverage in connection with such a 
plan) seeks an exemption under this paragraph, 
determinations under subparagraph (A) shall be 
made after such plan (or coverage) has com-
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