LD 566
pg. 11
Page 10 of 20 An Act to Ensure Equality in Mental Health Coverage Page 12 of 20
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LR 22
Item 1

 
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.

 
(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.

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

 
(3)__If benefits and coverage provided for treatment
of physical illness are provided on an expense-
incurred basis, the benefits and coverage required
under this subsection may be delivered separately
under a managed care system.

 
(4)__A policy or contract may not have separate
maximums for physical illness and mental illness,
separate deductibles and coinsurance amounts for
physical illness and mental illness, separate out-of-
pocket limits in a benefit period of not more than 12
months for physical illness and mental illness or
separate office visitation limits for physical
illness and mental illness.

 
(5)__A health benefit plan may not impose a
limitation on coverage or benefits for mental illness
unless that same limitation is also imposed on the
coverage and benefits for physical illness covered
under the policy or contract.

 
(6)__Copayments required under a policy or contract for
benefits and coverage for mental illness must be actuarially
equivalent to any coinsurance requirements


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