LD 1319
pg. 429
Page 428 of 460 PUBLIC Law Chapter 20 Page 430 of 460
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LR 2000
Item 1

 
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 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.


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