AB 512

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

(mental health) and alcoholism and other drug abuse problems (substance abuse

problems) in the minimum amount of the lesser of: 1) the expenses of 30 days of

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 abuse 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 governmental self-insured

health plans of the state and municipalities. In addition, the bill requires group and

individual health benefit plans and governmental self-insured health 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 requires that deductibles, copayments, out-of-pocket limits,