33-22-706. Coverage for severe mental illness -- definition. (1) A policy or certificate of health insurance or disability insurance that is delivered, issued for delivery, renewed, extended, or modified in this state must provide a level of benefits for the necessary care and treatment of severe mental illness, as defined in subsection (6), that is no less favorable than that level provided for other physical illness generally. Benefits for treatment of severe mental illness may be subject to managed care provisions contained in the policy or certificate.
(2) Benefits provided pursuant to subsection (1) include but are not limited to:
(a) inpatient hospital services;
(b) outpatient services;
(c) rehabilitative services;
(e) services rendered by a licensed physician, licensed advanced practice registered nurse with a specialty in mental health, licensed social worker, licensed psychologist, or licensed professional counselor when those services are part of a treatment plan recommended and authorized by a licensed physician; and
(f) services rendered by a licensed advanced practice registered nurse with prescriptive authority and specializing in mental health.
(3) Benefits provided pursuant to this section must be included when determining maximum lifetime benefits, copayments, and deductibles.
(4) (a) This section applies to health service benefits provided by:
(i) individual and group health and disability insurance;
(ii) individual and group hospital or medical expense insurance;
(iii) medical subscriber contracts;
(iv) membership contracts of a health service corporation;
(v) health maintenance organizations; and
(vi) the comprehensive health association created by 33-22-1503.
(b) This section does not apply to the following coverages:
(ii) short-term travel;
(iii) accident only;
(iv) limited or specific disease;
(v) Title XVIII of the Social Security Act (medicare); or
(vi) any other similar coverage under state or federal government plans.
(5) This section does not limit benefits for an illness or condition that does not constitute a severe mental illness, as defined in subsection (6), but that does constitute a mental illness, as defined in 33-22-702.
(6) As used in this section, "severe mental illness" means the following disorders as defined by the American psychiatric association:
(b) schizoaffective disorder;
(c) bipolar disorder;
(d) major depression;
(e) panic disorder;
(f) obsessive-compulsive disorder; and
(7) Coverage for a child with autism who is 18 years of age or younger must comply with 33-22-515(3) through (5) if the child is diagnosed with:
(a) autistic disorder;
(b) Asperger's disorder; or
(c) pervasive developmental disorder not otherwise specified.
History: En. Sec. 1, Ch. 348, L. 1999; amd. Sec. 1, Ch. 367, L. 2001; amd. Sec. 5, Ch. 325, L. 2003; amd. Sec. 3, Ch. 359, L. 2009.