| | 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 reimbursing health maintenance | | organization, a provider of medical treatment for | | mental illness shall furnish data substantiating that | | initial or continued treatment is medically necessary | and appropriate health care. When making the | | determination of whether treatment is medically | necessary and appropriate health care, the provider | | shall use the same criteria for medical treatment for | | mental illness as for medical treatment for physical | | illness under the group contract. |
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| | | (3) If benefits and coverage for the 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. |
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| | | (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. |
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| | | (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. |
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| | | (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. |
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