Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS MENTAL ILLNESS. (a) A group health benefit plan:
(1) must provide coverage, based on medical necessity, for not less than the following treatments of serious mental illness in each calendar year:
(A) 45 days of inpatient treatment; and
(B) 60 visits for outpatient treatment, including group and individual outpatient treatment;
(2) may not include a lifetime limitation on the number of days of inpatient treatment or the number of visits for outpatient treatment covered under the plan; and
(3) must include the same amount limitations, deductibles, copayments, and coinsurance factors for serious mental illness as the plan includes for physical illness.
(b) A group health benefit plan issuer:
(1) may not count an outpatient visit for medication management against the number of outpatient visits required to be covered under Subsection (a)(1)(B); and
(2) must provide coverage for an outpatient visit described by Subsection (a)(1)(B) under the same terms as the coverage the issuer provides for an outpatient visit for the treatment of physical illness.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Section: Previous 1355.001 1355.002 1355.003 1355.004 1355.005 1355.006 1355.007 1355.015 1355.051 1355.052 1355.053 1355.054 1355.055 1355.056 1355.057 NextLast modified: September 28, 2016