BLAIR LEE III, Acting Governor                            2525

Article 48A - Insurance Code

354M.

(A) THIS SECTION APPLIES ONLY IF AN INITIAL
ENROLLMENT OF AT LEAST 25 CERTIFICATE HOLDERS SUBSCRIBERS
REASONABLY CAN BE EXPECTED UNDER A NEW OR EXPANDED GROUP
POLICY CONTRACT.

(B) EVERY NONPROFIT HEALTH INSURER SERVICE PLAN

PROVIDING HOSPITAL BENEFITS PROPOSING TO ISSUE IN THIS STATE
A GROUP HEALTH INSURANCE POLICY CONTRACT PROGRAM SHALL OFFER
TO THE APPLICANT GROUP POLICYHOLDER THE OPTION TO PROVIDE
BENEFITS FOR TREATMENT OF DRUG ABUSE EQUAL TO AT LEAST THE
FOLLOWING COVERAGE:

(1)    IN A 12-MONTH BENEFIT PERIOD, AT LEAST 21
DAYS INPATIENT TREATMENT IN A HOSPITAL OR RESIDENTIAL
TREATMENT FACILITY THAT THE DEPARTMENT OF HEALTH AND MENTAL
HYGIENE HAS CERTIFIED OR LICENSED FOR THAT PURPOSE; AND

(2)    IF THE POLICY IS A MAJOR MEDICAL INSURANCE
POLICY:

(I)    COVERAGE IN AN OUTPATIENT TREATMENT
PROGRAM THAT THE DEPARTMENT OF HEALTH AND MENTAL HYGIENE HAS
CERTIFIED OR LICENSEE FOR THAT PURPOSE; AND

(II)   COVERAGE SHALL BE FOR AT LEAST 80
PERCENT OF THE COST OF CARE, BUT IS NOT REQUIRED TO EXCEED
$1,000 IN ANY 12-MONTH PERIOD.

(C) FOR PURPOSES OF SUBSECTION (B) OF THIS SECTION, A
PROPOSED CHANGE IN BENEFITS UNDER AN EXISTING POLICE
CONTRACT IS A PROPOSAL TO ISSUE A POLICY CONTRACT.

(D) FOR THE PURPOSES OF THIS SECTION "DRUG ABUSE"

MEANS__AN UNCONTROLLABLE AND EXCESSIVE USE OF A DRUG OR DRUG

DERIVATIVE.

477Q.

(A) THIS SECTION APPLIES ONLY IF AN INITIAL
ENROLLMENT OF AT LEAST 25 CERTIFICATE HOLDERS REASONABLY CAN
BE EXPECTED UNDER A NEW OR EXPANDED GROUP POLICY.

(B) EVERY NONPROFIT HEALTH INSURER PROPOSING TO ISSUE
OR DELIVER IN THIS STATE A GROUP OR BLANKET HOSPITAL OR
MAJOR MEDICAL INSURANCE POLICY SHALL OFFER THE APPLICANT
GROUP POLICYHOLDER THE OPTION TO PROVIDE BENEFITS FOR
TREATMENT OF DRUG ABUSE EQUAL TO AT LEAST THE FOLLOWING
COVERAGE:

(1) IN ANY 12-MONTH BENEFIT PERIOD, AT LEAST 21
DAYS INPATIENT TREATMENT IN A HOSPITAL OR RESIDENTIAL
TREATMENT FACILITY THAT THE DEPARTMENT OF HEALTH AND MENTAL
HYGIENE HAS CERTIFIED OR LICENSED FOR THAT PURPOSE; AND