<html> <head> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p align=center><b>CHAPTER 20:06:58</b></p> <p align=center><b>&nbsp;</b></p> <p align=center><b>MENTAL HEALTH PARITY</b></p> <p align=center><b>&nbsp;</b></p> <p align=center><b>&nbsp;</b></p> <p>Section</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:01">20:06:58:01</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Definitions.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:02">20:06:58:02</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Parity requirements with respect to aggregate lifetime and annual dollar limits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:03">20:06:58:03</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Plan with no limit or limits on less than one-third of all medical or surgical benefits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:04">20:06:58:04</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Plan with a limit on at least two-thirds of all medical or surgical benefits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:05">20:06:58:05</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Determining one-third and two-thirds of all medical or surgical benefits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:06">20:06:58:06</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Plan not described in sections <a href="DisplayRule.aspx?Rule=20:06:58:03">20:06:58:03</a> or 20:06:58:04 of this chapter.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:07">20:06:58:07</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Parity requirements with respect to financial requirements and treatment limitations -- Clarification of classification of benefits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:08">20:06:58:08</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Parity requirements with respect to financial requirements and treatment limitations -- Clarification of type of financial requirement or treatment limitation.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:09">20:06:58:09</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Parity requirements with respect to financial requirements and treatment limitations -- Clarification of level of a type of financial requirement or treatment limitation.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:10">20:06:58:10</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Parity requirements with respect to financial requirements and treatment limitations -- Clarification of coverage unit.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:11">20:06:58:11</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; General parity requirement.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:12">20:06:58:12</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Classifications of benefits used for applying rules.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:13">20:06:58:13</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Application to out-of-network providers.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:14">20:06:58:14</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Financial requirements and quantitative treatment limitations -- Determining substantially all.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:15">20:06:58:15</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Financial requirements and quantitative treatment limitations -- Determining predominant.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:16">20:06:58:16</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Financial requirements and quantitative treatment limitations -- Determining portion based on plan payments.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:17">20:06:58:17</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Financial requirements and quantitative treatment limitations -- Determining clarifications for certain threshold requirements and dollar amount of plan payments.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:18">20:06:58:18</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Application to different coverage units.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:19">20:06:58:19</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Special rule for&nbsp; multi-tiered prescription drug benefits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:20">20:06:58:20</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Special rule for multiple network tiers.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:21">20:06:58:21</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Special rule for sub-classifications permitted for office visits, separate from other outpatient services.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:22">20:06:58:22</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; No separate cumulative financial requirements or cumulative quantitative treatment limitations.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:23">20:06:58:23</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Nonquantitative treatment limitations.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:24">20:06:58:24</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Illustrative list of nonquantitative treatment limitations.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:25">20:06:58:25</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Exemptions.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:26">20:06:58:26</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Availability of plan information -- Criteria for medical necessity determinations.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:27">20:06:58:27</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Availability of plan information -- Reasons for denial.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:28">20:06:58:28</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Applicability and effective dates -- Group health plans.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:29">20:06:58:29</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Applicability and effective dates -- Health insurance issuers.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:30">20:06:58:30</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Scope.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:31">20:06:58:31</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Coordination with EHB requirements.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:32">20:06:58:32</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Small employer exemption.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:33">20:06:58:33</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Determining employer size.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:34">20:06:58:34</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Increased cost exemption.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:35">20:06:58:35</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Applicable percentage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:36">20:06:58:36</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Determinations by actuaries.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:37">20:06:58:37</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Formula.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:38">20:06:58:38</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Six month determination.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:39">20:06:58:39</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Notification.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:40">20:06:58:40</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Participants and beneficiaries -- Content of notice.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:41">20:06:58:41</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Use of summary of material reductions in covered services or benefits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:42">20:06:58:42</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Delivery.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:43">20:06:58:43</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Availability of documentation.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:44">20:06:58:44</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Sale of nonparity health insurance coverage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:58:45">20:06:58:45</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Special effective date for certain collective-bargained plans.</p> </div> </body> </html>