LD 1158
pg. 4
Page 3 of 7 An Act to Ensure Equality in Mental Health Coverage for Children and Adults ... Page 5 of 7
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LR 14
Item 1

 
(5) Panic disorder;

 
(6) Obsessive-compulsive disorder; or

 
(7) Major depressive disorder.; or

 
(8)__Eating disorders:

 
(a)__Bulimia; and

 
(b)__Anorexia.

 
B. Every nonprofit hospital and medical services
organization and nonprofit health care plan must make
available coverage in all individual and group policies,
contracts and certificates executed, delivered, issued for
delivery, continued or renewed in this State on or after
July 1, 1996 that provides benefits meeting the requirements
of this paragraph. For purposes of this paragraph, all
contracts are deemed renewed no later than the next yearly
anniversary of the contract date.

 
(1) The offer of coverage must provide benefits for
the treatment and diagnosis of mental illnesses under
terms and conditions that are no less extensive than
the benefits provided for medical treatment for
physical illnesses. A health insurance plan must
provide coverage for treatment of a mental condition
and may not establish a rate, term or condition that
places a greater financial burden on an insured for
access to treatment for a mental health condition than
for access to treatment for a physical health
condition.__Any deductible or out-of-pocket limits
required under a health insurance plan must be
comprehensive for coverage of both mental health and
physical health conditions.

 
(2) At the request of a nonprofit hospital or medical
service organization, a provider of medical treatment
for mental illness shall furnish data substantiating
that initial or continued treatment is medically
necessary and appropriate. When making the
determination of whether treatment is medically
necessary and appropriate, the provider shall use the
same criteria for medical treatment for mental illness
as for medical treatment for physical illness under the
individual or group contract.


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