(a) As used in this Code section, the term: (1) "Accident and sickness insurance benefit plan, policy, or
contract" means: (A) A group or blanket accident and sickness insurance policy or
contract, as defined in Chapter 30 of this title; (B) A group contract of the type issued by a nonprofit hospital
service corporation established under Chapter 19 of this title; (C) A group contract of the type issued by a health care plan
established under Chapter 20 of this title; (D) A group contract of the type issued by a nonprofit medical
service corporation established under Chapter 18 of this title; (E) A group contract of the type issued by a health maintenance
organization established under Chapter 21 of this title; or (F) Any similar group 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) This Code section shall apply only to accident and sickness insurance benefit plans, policies, or contracts, certificates evidencing coverage under a policy of insurance, or any other evidence of insurance issued by an insurer, delivered, or issued for delivery in this state, except for policies issued to an employer in another state which provide coverage for employees in this state who are employed by such employer policyholder, providing major medical benefits covering all groups except small groups as defined in subsection (a) of Code Section 33-30-12. (c) 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, 1998, coverage for the treatment of mental disorders, which
coverage shall be at least as extensive and provide at least the
same degree of coverage and the same annual and lifetime dollar
limits 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. (d)(1) The optional endorsement required to be made available
under subsection (c) of this Code section shall not contain any
exclusions, reductions, or other limitations as to coverages,
including without limitation limits on the number of inpatient
treatment days and outpatient treatment visits, 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,
except as otherwise provided in paragraph (2) of this subsection. (2) The optional endorsement required to be made available under
subsection (c) of this Code section may contain deductibles or
coinsurance provisions which apply to the treatment of mental
disorders, and such deductibles or coinsurance provisions need not
apply generally to other similar benefits provided or paid for
under the accident and sickness insurance benefit plan, policy, or
contract; provided, however, that if a separate deductible applies
to the treatment of mental disorders, it shall not exceed the
deductible for medical or surgical coverages. A separate
out-of-pocket limit may be applied to the treatment of mental
disorders, which limit, in the case of an indemnity type plan,
shall not exceed the maximum out-of-pocket limit for medical or
surgical coverages and which, in the case of a health maintenance
organization plan, shall not exceed the maximum out-of-pocket
limit for medical or surgical coverages or the amount of $2,000.00
in 1998 and as annually adjusted thereafter according to the
Consumer Price Index for health care, whichever is greater. (e)(1) 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. (2) Nothing in this Code section shall be construed to prohibit
any person issuing an accident and sickness insurance benefit
plan, policy, or contract from providing the coverage required to
be made available under subsection (c) of this Code section
through an indemnity plan with or without designating preferred
providers of services or from arranging for or providing services
instead of indemnifying against the cost of such services, without
regard to whether such method of providing coverage for treatment
of mental disorders applies generally to other similar benefits
provided or paid for under the accident and sickness insurance
benefit plan, policy, or contract. (f) The requirements of this Code section with respect to a group or
blanket accident and sickness insurance benefit plan, policy, or
contract shall be satisfied if the coverage specified in subsections
(c) and (d) of this Code section is made available to the master
policyholder of such plan, policy, or contract. Nothing in this
Code section shall be construed to require the group insurer,
nonprofit corporation, health care plan, health maintenance
organization, or master policyholder to provide or make available
such coverage to any insured under such group or blanket plan,
policy, or contract. |