Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED
Section 031-330-11 - Federal Parity Requirements
Universal Citation: 02 ME Code Rules ยง 031-330-11
Current through 2024-38, September 18, 2024
This section applies to all policies identified in section 3 to the extent they cover large employers and are issued or renewed on or after January 1, 1998. This section applies only to conditions other than those listed in 24-A M.R.S.A. §2843(5-C).
A. Annual Maximums for Unlisted Conditions.
1. If the policy contains no annual dollar
maximum for other illnesses, it shall contain no annual dollar maximum for
mental illness, but may include annual maximum numbers of visits if the maximum
is not less than the following:
a. For
outpatient care, 40 visits; and
b.
For home health care services, 40 visits.
2. If the policy contains an annual dollar
maximum for other illnesses, it may:
a. Apply
that maximum to the policy as a whole, including mental illness, or
b. Include a separate annual dollar maximum
for mental illness that is no less than the annual maximum for other illnesses,
or
c. Include annual maximum
numbers of visits if the maximum is not less than that permitted in Paragraph
1.
3. Any maximum
applies to benefits actually paid, net of any applicable discount.
B. Maximum Lifetime Benefit for Unlisted Conditions.
1. If the policy
contains no lifetime maximum for other illnesses, it shall contain no lifetime
maximum for mental illness.
2. If
the policy contains a lifetime maximum for other illnesses, it may:
a. Apply that maximum to the policy as a
whole, including mental illness, or
b. Include a separate lifetime maximum for
mental illness that is no less than the lifetime maximum for other
illnesses.
3. Any
maximum applies to benefits actually paid, net of any applicable
discount.
Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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