(a) As used in this Code section, the term: (1) "Accident and sickness insurance benefit plan, policy, or
contract" means: (A) An individual accident and sickness insurance policy or
contract, as defined in Chapter 29 of this title; or (B) Any similar individual accident and sickness benefit plan,
policy, or contract. (2) "Mental disorder" shall have the same meaning as defined by
The_Diagnostic_and_Statistical_Manual_of_Mental_Disorders
(American Psychiatric Association) or The_International
Classification_of_Diseases (World Health Organization) as of
January 1, 1981, or as the Commissioner may further define such
term by rule and regulation. (b) Every insurer authorized to issue accident and sickness
insurance benefit plans, policies, or contracts shall be required to
make available, either as a part of or as an optional endorsement to
all such policies providing major medical insurance coverage which
are issued, delivered, issued for delivery, or renewed on or after
July 1, 1984, coverage for the treatment of mental disorders, which
coverage shall be at least as extensive and provide at least the
same degree of coverage as that provided by the respective plan,
policy, or contract for the treatment of other types of physical
illnesses. Such an optional endorsement shall also provide that the
coverage required to be made available pursuant to this Code section
shall also cover the spouse and the dependents of the insured if the
insured's spouse and dependents are covered under such benefit plan,
policy, or contract. In no event shall such an insurer be required
to cover inpatient treatment for more than a maximum of 30 days per
policy year or outpatient treatment for more than a maximum of 48
visits per policy year under individual policies. (c) The optional endorsement required to be made available under
subsection (b) of this Code section shall not contain any
exclusions, reductions, or other limitations as to coverages,
deductibles, or coinsurance provisions which apply to the treatment
of mental disorders unless such provisions apply generally to other
similar benefits provided or paid for under the accident and
sickness insurance benefit plan, policy, or contract. (d) Nothing in this Code section shall be construed to prohibit an
insurer, nonprofit corporation, health care plan, health maintenance
organization, or other person issuing any similar accident and
sickness insurance benefit plan, policy, or contract from issuing or
continuing to issue an accident and sickness insurance benefit plan,
policy, or contract which provides benefits greater than the minimum
benefits required to be made available under this Code section or
from issuing any such plans, policies, or contracts which provide
benefits which are generally more favorable to the insured than
those required to be made available under this Code section. (e) Nothing in this Code section shall be construed to prohibit the
inclusion of coverage for the treatment of mental disorders that
differs from the coverage provided in the same insurance plan,
policy, or contract for physical illnesses if the policyholder does
not purchase the optional coverage made available pursuant to this
Code section. |