33-24-29
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33-24-29.
(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 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, but which may provide
for different limits on the number of inpatient treatment days and outpatient
treatment visits, 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
insured́s
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 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 for any differing limits on inpatient treatment days and
outpatient treatment visits as provided under subsection (c) of this Code
section and 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.
(g)
This Code section is neither enacted pursuant to nor intended to implement the
provisions of any federal law.