| | | (3)__If benefits and coverage 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 visit 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, may not | | be greater than any copayment or coinsurance required | | under the policy or contract for a benefit or coverage | | for a physical illness. |
|
| | | (7)__For the purposes of this section, a medication | | management visit 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 . |
|
| | | Sec. VV-6. 24 MRSA §2325-A, sub-§5-D, as amended by PL 1995, c. 637, | | §2, is further amended to read: |
|
| | | 5-D. Mandated offer of coverage for certain mental illnesses. | | Except as otherwise provided, coverage for medical |
|
|