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2005 LAWS OF MARYLAND
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Ch. 172
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(c) (1) The benefits under this section shall be required only for expenses
arising for treatment of mental illnesses, emotional disorders, drug abuse and alcohol
abuse which in the professional judgment of practitioners is medically necessary and
treatable.
(2) The benefits required under this section shall be provided as one set
of benefits covering mental illnesses, emotional disorders, drug abuse and alcohol
abuse.
(3) The benefits required under this section may be delivered under a
managed care system.
(4) Except as specifically provided in this section, benefits for illnesses
covered by this section and the benefits for physical illnesses covered under a contract
or certificate shall have the same terms and conditions.
(5) Except for the coinsurance provisions in subsection (b)(2)(iii) of this
section, a contract or certificate that is subject to this section may not have:
(i) Separate lifetime maximums for physical illnesses and illnesses
covered under this section;
(ii) Separate deductibles and coinsurance amounts for physical
illnesses and illnesses covered under this section; or
(iii) Separate out-of-pocket limits in a benefit period of not more
than 12 months for physical illnesses and illnesses covered under this section.
(6) (I) [Any] SUBJECT TO SUBPARAGRAPH (II) OF THIS PARAGRAPH,
ANY copayments required under a contract or certificate for benefits for illnesses
covered under this section shall be:
[(i)] 1. Actuarially equivalent to any coinsurance requirements
under this section; or
[(ii)] 2. Where there are no coinsurance requirements, not greater
than a copayment required for a benefit under the contract or a certificate for a
physical illness.
(II) A HEALTH MAINTENANCE ORGANIZATION MAY NOT CHARGE A
COPAYMENT THAT IS GREATER THAN 50% OF THE DAILY COST FOR METHADONE
MAINTENANCE TREATMENT.
Article - Insurance
15-802.
(c) A policy or contract subject to this section may not discriminate against an
individual with a mental illness, emotional disorder, drug abuse disorder, or alcohol
abuse disorder by failing to provide benefits for the diagnosis and treatment of these
illnesses under the same terms and conditions that apply under the policy or contract
for the diagnosis and treatment of physical illnesses.
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- 1096 -
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