coverage.
1.An insurance company, nonprofit health service corporation, or health maintenance
organization may not deliver, issue, execute, or renew any health insurance policy or
health service contract on a group, blanket, franchise, or association basis unless the
policy or contract provides benefits, of the same type offered under the policy or
contract for other illnesses, for health services to any individual covered under the
policy or contract, for the diagnosis, evaluation, and treatment of alcoholism, drug
addiction, or other related illness, which benefits meet or exceed the benefits provided
in subsection 2.
2.The benefits must be provided for inpatient treatment, treatment by partial
hospitalization, and outpatient treatment:
a.In the case of benefits provided for inpatient
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coverage.
1. An insurance company, nonprofit health service corporation, or health maintenance
organization may not deliver, issue, execute, or renew any health insurance policy or
health service contract on a group, blanket, franchise, or association basis unless the
policy or contract provides benefits, of the same type offered under the policy or
contract for other illnesses, for health services to any individual covered under the
policy or contract, for the diagnosis, evaluation, and treatment of alcoholism, drug
addiction, or other related illness, which benefits meet or exceed the benefits provided
in subsection 2.
2. The benefits must be provided for inpatient treatment, treatment by partial
hospitalization, and outpatient treatment:
a. In the case of benefits provided for inpatient treatment, the benefits must be
provided for a minimum of sixty days of services covered under this section and
section 26.1-36-09 in any calendar year. Services provided under this subdivision
must be provided by an addiction treatment program licensed under chapter
50-31.
b. In the case of benefits provided for partial hospitalization, the benefits must be
provided for a minimum of one hundred twenty days of services covered under
this section and section 26.1-36-09 in any calendar year. Services provided under
this subdivision must be provided by an addiction treatment program licensed
under chapter 50-31. For services provided in state-operated behavioral health
clinics, charges must be reasonably similar to the charges for care provided by
hospitals as defined in this subsection.
c. Benefits may also be provided for a combination of inpatient and partial
hospitalization treatment. For the purpose of computing the period for which
benefits are payable, each day of inpatient treatment is equivalent to two days of
treatment by partial hospitalization, provided that no more than forty-six days of
the inpatient treatment benefits required by this section may be traded for
treatment by partial hospitalization.
d. In the case of benefits provided for outpatient treatment, the benefits must be
provided for a minimum of twenty visits for services covered under this section in
any calendar year, provided the diagnosis, evaluation, and treatment services are
provided within the scope of licensure by a licensed physician, a licensed
psychologist who is eligible for listing on the national register of health service
providers in psychology, or the treatment services are provided within the scope
of licensure by a licensed addiction counselor. The insurance company, nonprofit
health service corporation, or health maintenance organization may not establish
a deductible or a copayment for the first five visits in any calendar year, and may
not establish a copayment greater than twenty percent for the remaining visits.
The deductible limitation of this subdivision does not apply to a high-deductible
health plan used to establish a health savings account pursuant to and as defined
in section 223 of the Internal Revenue Code [26 U.S.C. 223].
e. If the services are provided by a provider outside a preferred provider network
without a referral from within the network, the insurance company, nonprofit
health service corporation, or health maintenance organization may establish a
copayment greater than twenty percent for only those visits after the first five
visits in any calendar year.
f. As used in this section and section 26.1-36-08.1, partial hospitalization means
continuous treatment for at least three hours, but not more than twelve hours, in
any twenty-four-hour period and includes the medically necessary treatment
services provided by licensed professionals under the supervision of a licensed
physician.
3. This section does not prevent any insurance company, nonprofit health service
corporation, or health maintenance organization from issuing, delivering, or renewing,
at its option, any policy or contract containing provisions similar to those required by
this section, when the policy or contract is not subject to such provisions.