H.B. 1197

VETOES

                 (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) ANY COPAYMENTS REQUIRED UNDER A CONTRACT OR
CERTIFICATE FOR BENEFITS FOR ILLNESSES COVERED UNDER THIS SECTION SHALL
BE:

(I)       ACTUARIALLY EQUIVALENT TO ANY . COINSURANCE
REQUIREMENTS UNDER THIS SECTION; OR

(II)     WHERE THERE ARE NO COINSURANCE REQUIREMENTS, NOT
GREATER THAN A COPAYMENT REQUIRED FOR BENEFITS A BENEFIT UNDER THE
CONTRACT OR A CERTIFICATE FOR PHYSICAL ILLNESSES A PHYSICAL ILLNESS.

(D)     NOTWITHSTANDING THE PROVISIONS OF SUBSECTION (B)(2)(I)1 OF THIS
SECTION, UNTIL JULY 1, 1995, A CONTRACT OR POLICY THAT IS SUBJECT TO THIS
SECTION THAT OFFERS LESS THAN 60 DAYS COVERAGE FOR INPATIENT CARE FOR
HEALTH CARE FOR PHYSICAL ILLNESS MUST ONLY INCLUDE COVERAGE FOR
MENTAL ILLNESS, EMOTIONAL DISORDERS, DRUG ABUSE AND ALCOHOL ABUSE
THAT IS AT LEAST EQUAL TO THE BENEFIT OFFERED FOR THOSE OTHER TYPES OF
HEALTH CARE. ON AND AFTER JULY 1, 1995, THE PROVISIONS OF SUBSECTION
(B)(2)(I)2 OF THIS SECTION SHALL APPLY.

(E)     AN OFFICE VISIT TO A PHYSICIAN OR OTHER HEALTH CARE PROVIDER
FOR THE PURPOSE OF MEDICATION MANAGEMENT MAY NOT BE COUNTED AGAINST
THE NUMBER OF VISITS REQUIRED TO BE COVERED AS A PART OF THE BENEFITS
REQUIRED UNDER SUBSECTION (B)(2)(II) OF THIS SECTION AND SHALL BE
REIMBURSED UNDER THE SAME TERMS AND CONDITIONS AS AN OFFICE VISIT FOR
PHYSICAL ILLNESSES COVERED UNDER THE CONTRACT OR POLICY.

(F)      NOTHING IN THIS SECTION SHALL BE CONSTRUED TO PROHIBIT
EXCEEDING THE MINIMUM BENEFITS REQUIRED UNDER SUBSECTION (B)(2)(II) OF
THIS SECTION FOR ANY PARTIAL HOSPITALIZATION DAY THAT IS MEDICALLY
NECESSARY AND WOULD SERVE TO PREVENT INPATIENT HOSPITALIZATION.

Article - Health - General

19-703.1.

(A) (1) IN THIS SECTION THE FOLLOWING TERMS HAVE THE MEANINGS
INDICATED.

(2)      "ALCOHOL ABUSE" HAS THE MEANING STATED IN § 8-101 OF THE
HEALTH - GENERAL THIS ARTICLE.

(3)      "DRUG ABUSE" HAS THE MEANING STATED IN § 8-101 OF THE
HEALTH - GENERAL THIS ARTICLE.

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