WILLIAM DONALD SCHAEFER, Governor Ch. 587

benefits are payable shall be at least 30 days in any calendar
year or benefit period; (2) with respect to major medical expense
coverage, benefits, after the applicable deductible, for covered
expenses arising from all those services, other than inpatient,
which are rendered to treat acute mental illness and emotional
disorders, shall be at a rate which is not less than 65 percent
for the first 20 visits per calendar year or benefit period and
not less than 50 percent for any visits thereafter for that
calendar year or benefit period, of the benefits which the policy
provides for other types of illness; AND (3)(I) WITH RESPECT TO
BENEFITS FOR RESIDENCY IN A DEPARTMENT OF HEALTH AND MENTAL
HYGIENE APPROVED PSYCHIATRIC HALFWAY HOUSE, THE PERIOD OF
RESIDENCY FOR WHICH BENEFITS ARE PAYABLE SHALL BE AT LEAST 120
DAYS AND SHALL BE AT A RATE WHICH IS NOT LESS THAN 75 PERCENT OF
THE PER DIEM RATE WHICH AMOUNT MAY NOT EXCEED $30 PER DAY. (II)
JUSTIFICATION FOR LENGTH OF STAY SHALL BE DOCUMENTED BY A
QUALIFIED PSYCHIATRIST OR PSYCHOLOGIST BASED ON A MONTHLY
EVALUATION OF THE PATIENT WHICH IS AVAILABLE TO THE INSURANCE
COMPANY NONPROFIT HEALTH SERVICE PLAN AT THEIR REQUEST. (III) THE
NONPROFIT HEALTH SERVICE PLAN, AS A CONDITION PRECEDENT TO WE
ALLOWANCE FOR BENEFITS FOR RESIDENT IN A PSYCHIATRIC HALFWAY
HOUSE, MAY REQUIRE THE CERTIFICATION IN WRITING BY A LICENSED
PSYCHIATRIST OR PSYCHOLOGIST THAT RESIDENCE IN A PSYCHIATRIC
HALFWAY HOUSE IS MEDICALLY NECESSARY EITHER IN LIEU OF OR IN
COMBINATION WITH CONFINEMENT AS AN INPATIENT IN A HOSPITAL AND
WILL REDUCE THE LENGTH OF CONFINEMENT AS AN INPATIENT IN A

HOSPITAL. (IV) THE TOTAL BENEFITS PAYABLE FOR TREATMENT AS AN
INPATIENT IN A HOSPITAL OR RESIDENCY IN A PSYCHIATRIC HALFWAY
HOUSE OR A COMBINATION OF BOTH MAY NOT EXCEED THE COST OF
BENEFITS AVAILABLE ANNUALLY FOR TREATMENT AS AN INPATIENT IN A
HOSPITAL.

(b) The provisions of this section apply to all policies
issued, renewed, modified, altered, amended, or reissued on or
after July 1, 1973.

470E.

(a) Every individual hospital or major medical insurance
policy written on an expense-incurred basis which is delivered or
issued for delivery, within this State must include benefits for
expenses arising from treatment of acute mental illnesses and
emotional disorders which in the professional judgment of
practitioners are subject to significant improvement through
short-term therapy. These benefits must be at least equal to the
following minimum requirements: (1) with respect to benefits for
confinement as an inpatient in a hospital, the period of
confinement for which benefits are payable shall be at least 30
days in any calendar year or benefit period; (2) with respect to
major medical expense coverage, benefits, after the applicable
deductible, for covered expenses arising from all those services,
other than inpatient, which are rendered to treat acute mental
illness and emotional disorders, shall be at a rate which is not

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