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ROBERT L. EHRLICH, JR., Governor
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Ch. 172
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(d) It is not discriminatory under subsection (c) of this section if at least the
following benefits are provided:
(1) with respect to inpatient benefits for services provided in a licensed
or certified facility, including hospital inpatient benefits, the total number of days for
which benefits are payable and the terms and conditions that apply to those benefits
are at least equal to those that apply to the benefits available under the policy or
contract for physical illnesses;
(2) subject to subsection (g) of this section, with respect to benefits for
partial hospitalization, at least 60 days of partial hospitalization are covered under
the same terms and conditions that apply to the benefits available under the policy or
contract for physical illnesses; and
(3) with respect to outpatient coverage, other than for inpatient or
partial hospitalization services, benefits for covered expenses arising from services
provided to treat mental illnesses, emotional disorders, drug abuse, or alcohol abuse
are at a rate that, after the applicable deductible, is not less than:
(i) 80% for the first five visits in a calendar year or benefit period
of not more than 12 months;
(ii) 65% for the 6th through 30th visit in a calendar year or benefit
period of not more than 12 months; and
(iii) 50% for the 31st visit and any subsequent visit in a calendar
year or benefit period of not more than 12 months.
(e) (1) The benefits under this section are required only for expenses arising
from the treatment of mental illnesses, emotional disorders, drug abuse, or alcohol
abuse if, in the professional judgment of health care providers:
(i) the mental illness, emotional disorder, drug abuse, or alcohol
abuse is treatable; and
(ii) the treatment is medically necessary.
(2) The benefits required under this section:
(i) shall be provided as one set of benefits covering mental
illnesses, emotional disorders, drug abuse, and alcohol abuse;
(ii) shall have the same terms and conditions as the benefits for
physical illnesses covered under the policy or contract subject to this section, except
as specifically provided in this section; and
(iii) may be delivered under a managed care system.
(3) Except for the coinsurance requirements under subsection (d)(3) of
this section, a policy or contract subject to this section may not have:
(i) separate lifetime maximums for physical illnesses and illnesses
covered under this section;
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