Maine § 24-A §2843 Mental health services coverage

Maine Statutes

§ 24-A §2843 — Mental health services coverage

Maine·Title 24-A MAINE INSURANCE CODE·Ch. 35 GROUP AND BLANKET HEALTH INSURANCE

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 insurer 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

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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 insurer 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.
5-B.
Coverage for certain mental illness treatment.
5-C.
Coverage for treatment for certain mental illness.
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.
6.
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.
7.
Reports to the Superintendent of Insurance.
Every insurer 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 insurers in an annual report.
8.
Application.
This section does not apply to accidental injury, specified disease, hospital indemnity, Medicare supplement, long-term care or other limited benefit health insurance policies. 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.

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Legislative History

PL 1983, c. 515, §6 (NEW). PL 1983, c. 816, §B7 (AMD). PL 1987, c. 480, §6 (AMD). PL 1989, c. 490, §4 (AMD). PL 1991, c. 881, §§3,4 (AMD). PL 1991, c. 881, §§7,8 (AFF). PL 1993, c. 441, §§3,4 (AMD). PL 1993, c. 586, §§3,4 (AMD). PL 1995, c. 19, §2 (AMD). PL 1995, c. 332, §G2 (AMD). PL 1995, c. 407, §§6-9 (AMD). PL 1995, c. 560, §K82 (AMD). PL 1995, c. 560, §K83 (AFF). PL 1995, c. 625, §B8 (AMD). PL 1995, c. 625, §B9 (AFF). PL 1995, c. 637, §§4,5 (AMD). PL 2001, c. 354, §3 (AMD). PL 2003, c. 20, §§VV10-15 (AMD). PL 2003, c. 20, §VV25 (AFF). PL 2003, c. 517, §B16 (AMD). PL 2003, c. 689, §B6 (REV). PL 2017, c. 407, Pt. A, §96 (AMD). PL 2019, c. 5, Pt. D, §2 (AMD). PL 2021, c. 595, §§3-6 (AMD).