Under current law, a group health insurance policy (called a "disability
insurance policy" in the statutes) that provides coverage of any inpatient hospital
services must cover those services for the treatment of nervous and mental disorders
and alcoholism and other drug abuse problems (mental health and substance abuse
problems) in the minimum amount of the lesser of: 1) the expenses of 30 days of

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inpatient services; or 2) $7,000 minus the applicable cost sharing under the policy
or, if there is no cost sharing under the policy, $6,300 in equivalent benefits measured
in services rendered. If a group health insurance policy provides coverage of any
outpatient hospital services, it must cover those services for the treatment of mental
health and substance abuse problems in the minimum amount of $2,000 minus the
applicable cost sharing under the policy or, if there is no cost sharing under the policy,
$1,800 in equivalent benefits measured in services rendered. If a group health
insurance policy provides coverage of any inpatient or outpatient hospital services,
it must cover the cost of transitional treatment arrangements for the treatment of
mental health and substance abuse problems in the minimum amount of $3,000
minus the applicable cost sharing under the policy or, if there is no cost sharing under
the policy, $2,700 in equivalent benefits measured in services rendered. Transitional
treatment arrangements include services, specified by rule by the Commissioner of
Insurance, that are provided in a less restrictive manner than inpatient services but
in a more intensive manner than outpatient services. If a group health insurance
policy provides coverage for both inpatient and outpatient hospital services, the total
coverage for all types of treatment for mental health and substance problems is not
required to exceed $7,000, or the equivalent benefits measured in services rendered,
in a policy year.

This bill removes the specified minimum amounts of coverage that a group
health insurance policy must provide for the treatment of mental health and
substance abuse problems but retains the requirements with respect to providing the
coverage. Except for group plans providing limited benefits, the bill specifically
applies the requirements to all types of group health benefit plans, including defined
network plans, insurance plans offered by the state, and self-insured health plans
of the state and municipalities.

In addition, the bill requires group and individual health benefit plans and
governmental self-insured plans that provide coverage for the treatment of mental
health and substance abuse problems and that would cover at least one annual
physical examination to cover at least one annual screening for a covered individual
to determine the need for treatment of mental health and substance abuse problems
and for a female covered under the plan at least one screening during a pregnancy
for prepartum depression and at least one screening within six months after a live
birth, stillbirth, or miscarriage for postpartum depression to determine the need for
treatment. The bill also imposes a new requirement that the coverage under group
health benefit plans and governmental self-insured health plans for the treatment
of mental health and substance abuse problems must be the same as the coverage
under those plans for the treatment of physical conditions. This requirement for
equal coverage applies to such coverage components as deductibles, copayments,
annual and lifetime limits, and medical necessity definitions. The bill does not
require individual health benefit plans to cover the treatment of mental health and
substance abuse problems but, if an individual health benefit plan does cover the
treatment of any of those conditions, the individual health benefit plan must provide
the same coverage for that treatment as it does for the treatment of physical
conditions.