A. Subject to the limitations set forth in this section and Sections 6060.12 and 6060.13 of this title, any health benefit plan that is offered, issued, or renewed in this state on or after the effective date of this act shall provide benefits for treatment of severe mental illness.
B. Subject to the limitations set forth in this section and Sections 6060.12 and 6060.13 of this title, any health benefit plan offered, issued, or issued for delivery in this state on or after the effective date of this act may provide benefits for other forms of mental health or substance abuse disorder benefits.
C. 1. Benefits for mental health disorders, including, but not limited to those required by subsection A of this section, and for substance abuse disorder as provided in subsection B of this section shall be equal to benefits for treatment of and shall be subject to the same preauthorization and utilization review mechanisms and other terms and conditions as all other physical diseases and disorders, including, but not limited to:
a.coverage of inpatient hospital services for either twenty-six (26) days or the limit for other covered illnesses, whichever is greater,
b.coverage of outpatient services,
c.coverage of medication,
d.maximum lifetime benefits,
e.copayments,
f.coverage of home health visits,
g.individual and family deductibles, and
h.coinsurance.
2. Treatment limitations applicable to mental health or substance abuse disorder benefits shall be no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan. There shall be no separate treatment limitations that are applicable only with respect to mental health or substance abuse disorder benefits.
D. The provisions of this section shall not apply to coverage provided by a health benefit plan for a small employer.
Added by Laws 1999, c. 153, § 2, eff. Jan. 1, 2000. Amended by Laws 2010, c. 222, § 42, eff. Nov. 1, 2010.
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