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In Ontario alone, the TSAG study estimates these costs at $1.6 billion in annual direct health care costs, $4.4 billion in lost productivity, and at least 500,000 hospital days

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and (v) A discussion of the actions that have been or are being taken by the plan or issuer to address any material differences in access to mental health or substance use disorder benefits as compared to medical/surgical benefits, including the actions the plan or issuer has taken or is taking under 146.136(c)(4)(iii)(B)( 1 ) to address material differences to comply, in operation, with 146.136(c)(4), including, as applicable: (A) A reasoned explanation of any material differences in access to mental health or substance use disorder benefits as compared to medical/surgical benefits that persist despite reasonable actions that have been or are being taken