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CHAPTER 20:06:58

 

MENTAL HEALTH PARITY

 

 

Section

20:06:58:01        Definitions.

20:06:58:02        Parity requirements with respect to aggregate lifetime and annual dollar limits.

20:06:58:03        Plan with no limit or limits on less than one-third of all medical or surgical benefits.

20:06:58:04        Plan with a limit on at least two-thirds of all medical or surgical benefits.

20:06:58:05        Determining one-third and two-thirds of all medical or surgical benefits.

20:06:58:06        Plan not described in sections 20:06:58:03 or 20:06:58:04 of this chapter.

20:06:58:07        Parity requirements with respect to financial requirements and treatment limitations -- Clarification of classification of benefits.

20:06:58:08        Parity requirements with respect to financial requirements and treatment limitations -- Clarification of type of financial requirement or treatment limitation.

20:06:58:09        Parity requirements with respect to financial requirements and treatment limitations -- Clarification of level of a type of financial requirement or treatment limitation.

20:06:58:10        Parity requirements with respect to financial requirements and treatment limitations -- Clarification of coverage unit.

20:06:58:11        General parity requirement.

20:06:58:12        Classifications of benefits used for applying rules.

20:06:58:13        Application to out-of-network providers.

20:06:58:14        Financial requirements and quantitative treatment limitations -- Determining substantially all.

20:06:58:15        Financial requirements and quantitative treatment limitations -- Determining predominant.

20:06:58:16        Financial requirements and quantitative treatment limitations -- Determining portion based on plan payments.

20:06:58:17        Financial requirements and quantitative treatment limitations -- Determining clarifications for certain threshold requirements and dollar amount of plan payments.

20:06:58:18        Application to different coverage units.

20:06:58:19        Special rule for  multi-tiered prescription drug benefits.

20:06:58:20        Special rule for multiple network tiers.

20:06:58:21        Special rule for sub-classifications permitted for office visits, separate from other outpatient services.

20:06:58:22        No separate cumulative financial requirements or cumulative quantitative treatment limitations.

20:06:58:23        Nonquantitative treatment limitations.

20:06:58:24        Illustrative list of nonquantitative treatment limitations.

20:06:58:25        Exemptions.

20:06:58:26        Availability of plan information -- Criteria for medical necessity determinations.

20:06:58:27        Availability of plan information -- Reasons for denial.

20:06:58:28        Applicability and effective dates -- Group health plans.

20:06:58:29        Applicability and effective dates -- Health insurance issuers.

20:06:58:30        Scope.

20:06:58:31        Coordination with EHB requirements.

20:06:58:32        Small employer exemption.

20:06:58:33        Determining employer size.

20:06:58:34        Increased cost exemption.

20:06:58:35        Applicable percentage.

20:06:58:36        Determinations by actuaries.

20:06:58:37        Formula.

20:06:58:38        Six month determination.

20:06:58:39        Notification.

20:06:58:40        Participants and beneficiaries -- Content of notice.

20:06:58:41        Use of summary of material reductions in covered services or benefits.

20:06:58:42        Delivery.

20:06:58:43        Availability of documentation.

20:06:58:44        Sale of nonparity health insurance coverage.

20:06:58:45        Special effective date for certain collective-bargained plans.


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