| | 5-C. Coverage for treatment for certain mental illnesses. | Coverage for medical treatment for mental illnesses listed in | paragraph A is subject to this subsection. |
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| A. All group contracts must provide, at a minimum, benefits | according to paragraph B, subparagraph (1) for a person | receiving medical treatment for any of the following mental | illnesses diagnosed by a licensed allopathic or osteopathic | physician or a licensed psychologist who is trained and has | received a doctorate in psychology specializing in the | evaluation and treatment of human behavior: |
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| (3) Pervasive developmental disorder, or autism; |
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| (6) Obsessive-compulsive disorder; or |
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| (7) Major depressive disorder.; |
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| B. All policies, contracts and certificates executed, | delivered, issued for delivery, continued or renewed in this | State on or after July 1, 1996 must provide benefits that | meet 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. |
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| (1) The contracts 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. |
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| (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 |
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