In Vermont and most other states, this bill does not apply to companies and organizations that "self-insure." Self-insured companies accept the financial risk associated with health care insurance claims, and do not contract with insurance companies to assume that risk. Self-insured companies are also governed by federal legislation that exempts them from parity bills.

This week, officials at Fletcher Allen Health Care in Burlington, Vermont's biggest hospital and one of the state's largest self-insured employers, showed significant leadership by deciding to offer employees parity coverage for the treatment of mental health and substance use disorders, according to a report by the Associated Press. The coverage will start January 1, 2004.
While hospital management had expressed opposition to parity during contract talks with nurses, they reversed their position a month after a study found that Vermont's parity law had not significantly increased insurance costs in the state.

Ken Libertoff, executive director of the Vermont Association for Mental Health, hailed the hospital's decision, and credited the hospital's leadership for the change.

"This issue carries implications beyond just the hospital itself," Libertoff said. "We think it sends a signal to other businesses -- certainly other health care providers."

He said he hoped they would "reaffirm that not only is insurance coverage for (mental) health care important, but based on our recent federally funded study there's now tangible evidence that the cost of coverage is minimal, particularly when weighed against the benefits."