| | |
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 or, if there are no coinsurance | | requirements, not greater than any copayment required | | under the policy or contract for a benefit or | | coverage for a physical illness. |
|
| | | (7)__For the purposes of this section, medication | | management visits associated with a mental illness | | must be covered in the same manner as a medication | | management visit for the treatment of a physical | | illness and may not be counted in the calculation of | | any maximum outpatient treatment visit limits. |
|
| | | This subsection does not apply to policies, contracts and | | certificates covering employees of employers with 20 or fewer | | employees, whether the group policy is issued to the employer, | | to an association, to a multiple-employer trust or to another | | entity. |
|
| | This subsection may not be construed to allow coverage and | benefits for the treatment of alcoholism or other drug | dependencies through the diagnosis of a mental illness listed | in paragraph A. |
|
|