§ 24 §2325-A — Mental health services coverage

Maine § 24 §2325-A

• Jurisdiction: Maine
• Title 24: INSURANCE
• Ch. 19: NONPROFIT HOSPITAL OR MEDICAL SERVICE ORGANIZATIONS

Text

1.
Findings.
The Legislature finds that:
2.
Policy and purpose.
The Legislature declares that it is the policy of this State to:
3.
Definitions.
For purposes of this section, unless the context otherwise indicates, the following terms have the following meanings.
4.
Requirement.
Every nonprofit hospital and medical service organization that issues group health care contracts providing coverage to residents of this State shall provide benefits as required in this section to any subscriber or other person covered under those contracts for conditions arising from mental illness.
5.
Services.
Each group contract must provide for medically necessary health care for a person suffering from mental illness. Medically necessary health care includes, but is not limited to, the following services for a person suffering from a mental illness:
5-A.
Exceptions.
This section shall not apply to employee group insurance contracts issued to employers with 20 or fewer employees insured under the group contract or to group contracts designed primarily to supplement the Civilian Health and Medical Program of the Uniformed Services, as defined in the United States Code, Title 10, Section 1072, subsection 4.
5-B.
Coverage for certain mental illness treatment.
5-C.
Coverage for treatment for certain mental illnesses.
Coverage for medical treatment for mental illnesses listed in paragraph A‑1 is subject to this subsection.
5-D.
Mandated offer of coverage for certain mental illnesses.
Except as otherwise provided, coverage for medical treatment for mental illnesses listed in paragraph A by all individual and group nonprofit hospital and medical service organization health care plan contracts is subject to this subsection.
6.
Contracts; providers.
Subject to the approval by the Superintendent of Insurance pursuant to section 2305, a nonprofit hospital and a medical service organization incorporated under this chapter shall offer contracts to providers authorizing the provision of mental health services within the scope of the provider's licensure.
7.
Limits; coinsurance; deductibles.
Any policy or contract which provides coverage for the services required by this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section.
8.
Reports to the Superintendent of Insurance.
Every nonprofit hospital or medical service organization subject to this section shall report its experience for each calendar year to the superintendent not later than April 30th of the following year. The report must be in a form prescribed by the superintendent and include the amount of claims paid in this State for the services required by this section and the total amount of claims paid in this State for group health care contracts, both separated between those paid for inpatient, day treatment and outpatient services. The superintendent shall compile this data for all nonprofit hospital or medical service organizations in an annual report.
9.
Application; expiration.
10.
Application.
Except as otherwise provided in this section, the requirements of this section apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.

Legislative History

PL 1983, c. 515, §4 (NEW). PL 1987, c. 480, §2 (AMD). PL 1989, c. 490, §1 (AMD). PL 1991, c. 881, §§1,2 (AMD). PL 1991, c. 881, §§7,8 (AFF). PL 1993, c. 441, §§1,2 (AMD). PL 1993, c. 586, §§1,2 (AMD). PL 1995, c. 19, §1 (AMD). PL 1995, c. 332, §G1 (AMD). PL 1995, c. 407, §§1-4 (AMD). PL 1995, c. 560, §K82 (AMD). PL 1995, c. 560, §K83 (AFF). PL 1995, c. 625, §B6 (AMD). PL 1995, c. 625, §B7 (AFF). PL 1995, c. 637, §§1,2 (AMD). PL 1999, c. 256, §O1 (AMD). PL 2001, c. 354, §3 (AMD). PL 2003, c. 20, §§VV1-7 (AMD). PL 2003, c. 20, §VV25 (AFF). PL 2003, c. 517, §B6 (AMD). PL 2003, c. 689, §B6 (REV). PL 2017, c. 407, Pt. A, §93 (AMD).