WILLIAM DONALD SCHAEFER, Governor

Ch. 2

SAME TERMS AND CONDITIONS THAT APPLY TO BENEFITS AVAILABLE UNDER THE
CONTRACT OR CERTIFICATE FOR PHYSICAL ILLNESS; AND

2. ON OR AFTER JULY 1, 1995, AT LEAST EQUAL TO THE SAME
TERMS AND CONDITIONS THAT APPLY TO THE BENEFITS AVAILABLE UNDER THE
CONTRACT OR CERTIFICATE FOR PHYSICAL ILLNESS;

(II)     SUBJECT TO SUBSECTION (F) OF THIS SECTION, WITH RESPECT
TO BENEFITS FOR PARTIAL HOSPITALIZATION, AT LEAST 60 DAYS OF PARTIAL
HOSPITALIZATION SHALL BE COVERED UNDER THE SAME TERMS AND CONDITIONS
THAT APPLY TO THE BENEFIT AVAILABLE UNDER THE CONTRACT OR CERTIFICATE
FOR PHYSICAL ILLNESS; AND

(III)    WITH RESPECT TO OUTPATIENT COVERAGE, OTHER THAN FOR
INPATIENT OR PARTIAL HOSPITALIZATION SERVICES, BENEFITS FOR COVERED
EXPENSES ARISING FROM SERVICES WHICH ARE RENDERED TO TREAT MENTAL
ILLNESS, EMOTIONAL DISORDERS, DRUG ABUSE AND ALCOHOL ABUSE SHALL BE AT
A RATE WHICH IS, AFTER THE APPLICABLE DEDUCTIBLE, NOT LESS THAN:

1.        80 PERCENT FOR THE FIRST 5 VISITS IN ANY CALENDAR
YEAR OR BENEFIT PERIOD OF NOT MORE THAN 12 MONTHS;

2.        65 PERCENT FOR THE 6TH TO THROUGH 30TH VISIT IN
ANY CALENDAR YEAR OR BENEFIT PERIOD OF NOT MORE THAN 12 MONTHS; AND

3.        50 PERCENT FOR THE 31ST VISIT AND ANY VISIT AFTER
THE 31ST VISIT IN ANY CALENDAR YEAR OR BENEFIT PERIOD OF NOT MORE THAN 12
MONTHS.

(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 AS PROVIDED 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;

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