Senate Bill No. 356–Senator Townsend

March 10, 1999

____________

Referred to Committee on Commerce and Labor

 

SUMMARY—Revises provisions governing parity for insurance benefits for treatment of conditions relating to mental health. (BDR 57-682)

FISCAL NOTE: Effect on Local Government: Yes.

Effect on the State or on Industrial Insurance: Yes.

~

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).

 

AN ACT relating to insurance; providing in skeleton form for the revision of the provisions governing parity for insurance benefits for the treatment of conditions relating to mental health; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

1-1 Section 1. Chapter 689A of NRS is hereby amended by adding thereto

1-2 a new section to read as follows:

1-3 1. Notwithstanding any provision of this Title to the contrary, a

1-4 policy of health insurance issued or delivered for issuance in this state

1-5 pursuant to this chapter must provide coverage for the treatment of

1-6 conditions relating to mental health and must not establish any rate, term

1-7 or condition that places a greater financial burden on the insured person

1-8 for access to treatment for conditions relating to mental health than for

1-9 access to treatment for conditions relating to physical health. Any limits

1-10 required under the policy of health insurance for deductibles and out-of-

1-11 pocket expenses must be comprehensive for coverage of both conditions

1-12 relating to mental health and conditions relating to physical health.

1-13 2. A policy of health insurance that does not otherwise provide for

1-14 managed care, or that does not provide for the same degree of managed

1-15 care for all health conditions, may provide coverage for the treatment of

1-16 conditions relating to mental health through a managed care

1-17 organization if the managed care organization is in compliance with

2-1 regulations adopted by the commissioner which ensure that the system

2-2 for delivery of the treatment for conditions relating to mental health does

2-3 not diminish or negate the purpose of this section. The regulations

2-4 adopted by the commissioner must ensure that:

2-5 (a) Timely and appropriate access to care is available;

2-6 (b) The distribution of providers of health care who provide services

2-7 relating to mental health is adequate to serve the needs of persons in this

2-8 state, considering the quality, location and area of specialization of such

2-9 providers; and

2-10 (c) Administrative or clinical protocols do not reduce access to

2-11 medically necessary treatment for the insured person.

2-12 3. A policy of health insurance shall be deemed to be in compliance

2-13 with this section if the policy provides to the insured person at least one

2-14 option for treatment of conditions relating to mental health which has

2-15 rates, terms and conditions that impose no greater financial burden on

2-16 the insured person than that imposed for treatment of conditions relating

2-17 to the physical health of the insured person. The commissioner may

2-18 disapprove any policy of health insurance if he determines that the policy

2-19 is inconsistent with this section.

2-20 4. Benefits provided pursuant to this section by a policy of health

2-21 insurance for conditions relating to mental health must be paid in the

2-22 same manner as benefits for any other illness covered by the policy.

2-23 5. Benefits for conditions relating to mental health are not required

2-24 by this section if the treatment for the condition relating to mental health

2-25 is not provided:

2-26 (a) By a person who is licensed or certified to provide treatment for

2-27 conditions relating to mental health; or

2-28 (b) In a mental health facility or institution designated as a division

2-29 facility pursuant to NRS 433.233, or in a medical or other facility

2-30 licensed by the state board of health pursuant to chapter 449 of NRS that

2-31 provides programs for the treatment of conditions relating to mental

2-32 health, and pursuant to an individualized written plan developed for the

2-33 insured person. A nonprofit hospital or medical service corporation may

2-34 require a mental health facility or a person who is licensed or certified to

2-35 provide treatment for conditions relating to mental health to enter into a

2-36 contract as a condition of providing benefits in accordance with this

2-37 section.

2-38 6. The provisions of this section must not be construed to:

2-39 (a) Limit the provision of specialized services covered by Medicaid for

2-40 persons with conditions relating to mental health or substance abuse.

3-1 (b) Supersede any provision of federal law, any federal or state policy

3-2 relating to Medicaid, or the terms and conditions imposed on any

3-3 Medicaid waiver granted to this state with respect to the provision of

3-4 services to persons with conditions relating to mental health or substance

3-5 abuse.

3-6 (c) Affect any existing policy of health insurance until its date of

3-7 renewal or, if the policy of health insurance is governed by a collective

3-8 bargaining agreement or employment contract, until the expiration of

3-9 that agreement or contract.

3-10 7. As used in this section:

3-11 (a) "Condition relating to mental health" means a condition or

3-12 disorder involving mental illness that falls within any of the diagnostic

3-13 categories listed in the section on mental disorders in the International

3-14 Classification of Diseases published by the United States Department of

3-15 Health and Human Services.

3-16 (b) "Managed care" has the meaning ascribed to it in NRS 695G.040.

3-17 (c) "Managed care organization" has the meaning ascribed to it in

3-18 NRS 695G.050.

3-19 (d) "Rate, term or condition" means any lifetime or annual limit on

3-20 payments, any requirement concerning deductibles, copayments,

3-21 coinsurance or other forms of cost sharing, any limit on out-of-pocket

3-22 costs or on visits to a provider of treatment, and any other financial

3-23 component of health insurance coverage that affects the insured person.

3-24 Sec. 2. NRS 689A.040 is hereby amended to read as follows:

3-25 689A.040 1. Except as otherwise provided in subsections 2 and 3,

3-26 each such policy delivered or issued for delivery to any person in this state

3-27 must contain the provisions specified in NRS 689A.050 to 689A.170,

3-28 inclusive, and section 1 of this act, in the words in which the provisions

3-29 appear, except that the insurer may, at its option, substitute for one or more

3-30 of the provisions corresponding provisions of different wording approved

3-31 by the commissioner which are in each instance not less favorable in any

3-32 respect to the insured or the beneficiary. Each such provision must be

3-33 preceded individually by the applicable caption shown, or, at the option of

3-34 the insurer, by such appropriate individual or group captions or subcaptions

3-35 as the commissioner may approve.

3-36 2. Each policy delivered or issued for delivery in this state after

3-37 November 1, 1973, must contain a provision, if applicable, setting forth the

3-38 provisions of NRS 689A.045.

3-39 3. If any such provision is in whole or in part inapplicable to or

3-40 inconsistent with the coverage provided by a particular form of policy, the

3-41 insurer, with the approval of the commissioner, may omit from the policy

3-42 any inapplicable provision or part of a provision, and shall modify any

4-1 inconsistent provision or part of a provision in such a manner as to make

4-2 the provision as contained in the policy consistent with the coverage

4-3 provided by the policy.

4-4 Sec. 3. Chapter 689B of NRS is hereby amended by adding thereto a

4-5 new section to read as follows:

4-6 1. Notwithstanding any provision of this Title to the contrary, a

4-7 policy of group health insurance issued or delivered for issuance in this

4-8 state pursuant to this chapter must provide coverage for the treatment of

4-9 conditions relating to mental health and must not establish any rate, term

4-10 or condition that places a greater financial burden on the insured person

4-11 for access to treatment for conditions relating to mental health than for

4-12 access to treatment for conditions relating to physical health. Any limits

4-13 required under the policy of group health insurance for deductibles and

4-14 out-of-pocket expenses must be comprehensive for coverage of both

4-15 conditions relating to mental health and conditions relating to physical

4-16 health.

4-17 2. A policy of group health insurance that does not otherwise provide

4-18 for managed care, or that does not provide for the same degree of

4-19 managed care for all health conditions, may provide coverage for the

4-20 treatment of conditions relating to mental health through a managed

4-21 care organization if the managed care organization is in compliance with

4-22 regulations adopted by the commissioner which ensure that the system

4-23 for delivery of the treatment for conditions relating to mental health does

4-24 not diminish or negate the purpose of this section. The regulations

4-25 adopted by the commissioner must ensure that:

4-26 (a) Timely and appropriate access to care is available;

4-27 (b) The distribution of providers of health care who provide services

4-28 relating to mental health is adequate to serve the needs of persons in this

4-29 state, considering the quality, location and area of specialization of such

4-30 providers; and

4-31 (c) Administrative or clinical protocols do not reduce access to

4-32 medically necessary treatment for the insured person.

4-33 3. A policy of group health insurance shall be deemed to be in

4-34 compliance with this section if the policy provides to the insured person

4-35 at least one option for treatment of conditions relating to mental health

4-36 which has rates, terms and conditions that impose no greater financial

4-37 burden on the insured person than that imposed for treatment of

4-38 conditions relating to the physical health of the insured person. The

4-39 commissioner may disapprove any policy of group health insurance if he

4-40 determines that the policy is inconsistent with this section.

4-41 4. Benefits provided pursuant to this section by a policy of group

4-42 health insurance for conditions relating to mental health must be paid in

4-43 the same manner as benefits for any other illness covered by the policy.

5-1 5. Benefits for conditions relating to mental health are not required

5-2 by this section if the treatment for the condition relating to mental health

5-3 is not provided:

5-4 (a) By a person who is licensed or certified to provide treatment for

5-5 conditions relating to mental health; or

5-6 (b) In a mental health facility or institution designated as a division

5-7 facility pursuant to NRS 433.233, or in a medical or other facility

5-8 licensed by the state board of health pursuant to chapter 449 of NRS that

5-9 provides programs for the treatment of conditions relating to mental

5-10 health, and pursuant to an individualized written plan developed for the

5-11 insured person. A nonprofit hospital or medical service corporation may

5-12 require a mental health facility or a person who is licensed or certified to

5-13 provide treatment for conditions relating to mental health to enter into a

5-14 contract as a condition of providing benefits in accordance with this

5-15 section.

5-16 6. The provisions of this section must not be construed to:

5-17 (a) Limit the provision of specialized services covered by Medicaid for

5-18 persons with conditions relating to mental health or substance abuse.

5-19 (b) Supersede any provision of federal law, any federal or state policy

5-20 relating to Medicaid, or the terms and conditions imposed on any

5-21 Medicaid waiver granted to this state with respect to the provision of

5-22 services to persons with conditions relating to mental health or substance

5-23 abuse.

5-24 (c) Affect any existing policy of group health insurance until its date

5-25 of renewal or, if the policy of group health insurance is governed by a

5-26 collective bargaining agreement or employment contract, until the

5-27 expiration of that agreement or contract.

5-28 7. As used in this section:

5-29 (a) "Condition relating to mental health" means a condition or

5-30 disorder involving mental illness that falls within any of the diagnostic

5-31 categories listed in the section on mental disorders in the International

5-32 Classification of Diseases published by the United States Department of

5-33 Health and Human Services.

5-34 (b) "Managed care" has the meaning ascribed to it in NRS 695G.040.

5-35 (c) "Managed care organization" has the meaning ascribed to it in

5-36 NRS 695G.050.

5-37 (d) "Rate, term or condition" means any lifetime or annual limit on

5-38 payments, any requirement concerning deductibles, copayments,

5-39 coinsurance or other forms of cost sharing, any limit on out-of-pocket

5-40 costs or on visits to a provider of treatment, and any other financial

5-41 component of health insurance coverage that affects the insured person.

6-1 Sec. 4. NRS 689B.030 is hereby amended to read as follows:

6-2 689B.030 Each group health insurance policy must contain in

6-3 substance the following provisions:

6-4 1. A provision that, in the absence of fraud, all statements made by

6-5 applicants or the policyholders or by an insured person are representations

6-6 and not warranties, and that no statement made for the purpose of effecting

6-7 insurance voids the insurance or reduces its benefits unless the statement is

6-8 contained in a written instrument signed by the policyholder or the insured

6-9 person, a copy of which has been furnished to him or his beneficiary.

6-10 2. A provision that the insurer will furnish to the policyholder for

6-11 delivery to each employee or member of the insured group a statement in

6-12 summary form of the essential features of the insurance coverage of that

6-13 employee or member and to whom benefits thereunder are payable. If

6-14 dependents are included in the coverage, only one statement need be issued

6-15 for each family.

6-16 3. A provision that to the group originally insured may be added from

6-17 time to time eligible new employees or members or dependents, as the case

6-18 may be, in accordance with the terms of the policy.

6-19 4. A provision for benefits for [expense] expenses arising from care at

6-20 home or health supportive services if the care or service was prescribed by

6-21 a physician and would have been covered by the policy if performed in a

6-22 medical facility or facility for the dependent as defined in chapter 449 of

6-23 NRS.

6-24 5. A provision for benefits [payable] for expenses incurred for the

6-25 treatment of the abuse of alcohol or drugs, as provided in NRS 689B.036.

6-26 6. A provision for benefits for expenses arising from hospice care.

6-27 7. A provision for benefits for expenses incurred for the treatment of

6-28 conditions relating to mental health, as provided in section 3 of this act.

6-29 Sec. 5. NRS 689B.340 is hereby amended to read as follows:

6-30 689B.340 As used in NRS 689B.340 to [689B.600,] 689B.590,

6-31 inclusive, unless the context otherwise requires, the words and terms

6-32 defined in NRS 689B.350 to 689B.460, inclusive, have the meanings

6-33 ascribed to them in those sections.

6-34 Sec. 6. Chapter 689C of NRS is hereby amended by adding thereto a

6-35 new section to read as follows:

6-36 1. Notwithstanding any provision of this Title to the contrary, a

6-37 health benefit plan issued or delivered for issuance in this state pursuant

6-38 to this chapter must provide coverage for the treatment of conditions

6-39 relating to mental health and must not establish any rate, term or

6-40 condition that places a greater financial burden on the insured person

6-41 for access to treatment for conditions relating to mental health than for

7-1 access to treatment for conditions relating to physical health. Any limits

7-2 required under the health benefit plan for deductibles and out-of-pocket

7-3 expenses must be comprehensive for coverage of both conditions relating

7-4 to mental health and conditions relating to physical health.

7-5 2. A health benefit plan that does not otherwise provide for managed

7-6 care, or that does not provide for the same degree of managed care for

7-7 all health conditions, may provide coverage for the treatment of

7-8 conditions relating to mental health through a managed care

7-9 organization if the managed care organization is in compliance with

7-10 regulations adopted by the commissioner which ensure that the system

7-11 for delivery of the treatment for conditions relating to mental health does

7-12 not diminish or negate the purpose of this section. The regulations

7-13 adopted by the commissioner must ensure that:

7-14 (a) Timely and appropriate access to care is available;

7-15 (b) The distribution of providers of health care who provide services

7-16 relating to mental health is adequate to serve the needs of persons in this

7-17 state, considering the quality, location and area of specialization of such

7-18 providers; and

7-19 (c) Administrative or clinical protocols do not reduce access to

7-20 medically necessary treatment for the insured person.

7-21 3. A health benefit plan shall be deemed to be in compliance with

7-22 this section if the health benefit plan provides to the insured person at

7-23 least one option for treatment of conditions relating to mental health

7-24 which has rates, terms and conditions that impose no greater financial

7-25 burden on the insured person than that imposed for treatment of

7-26 conditions relating to the physical health of the insured person. The

7-27 commissioner may disapprove any health benefit plan if he determines

7-28 that the plan is inconsistent with this section.

7-29 4. Benefits provided pursuant to this section by a health benefit plan

7-30 for conditions relating to mental health must be paid in the same manner

7-31 as benefits for any other illness covered by the health benefit plan.

7-32 5. Benefits for conditions relating to mental health are not required

7-33 by this section if the treatment for the condition relating to mental health

7-34 is not provided:

7-35 (a) By a person who is licensed or certified to provide treatment for

7-36 conditions relating to mental health; or

7-37 (b) In a mental health facility or institution designated as a division

7-38 facility pursuant to NRS 433.233, or in a medical or other facility

7-39 licensed by the state board of health pursuant to chapter 449 of NRS that

7-40 provides programs for the treatment of conditions relating to mental

7-41 health, and pursuant to an individualized written plan developed for the

7-42 insured person. A nonprofit hospital or medical service corporation may

8-1 require a mental health facility or a person who is licensed or certified to

8-2 provide treatment for conditions relating to mental health to enter into a

8-3 contract as a condition of providing benefits in accordance with this

8-4 section.

8-5 6. The provisions of this section must not be construed to:

8-6 (a) Limit the provision of specialized services covered by Medicaid for

8-7 persons with conditions relating to mental health or substance abuse.

8-8 (b) Supersede any provision of federal law, any federal or state policy

8-9 relating to Medicaid, or the terms and conditions imposed on any

8-10 Medicaid waiver granted to this state with respect to the provision of

8-11 services to persons with conditions relating to mental health or substance

8-12 abuse.

8-13 (c) Affect any existing health benefit plan until its date of renewal or,

8-14 if the health benefit plan is governed by a collective bargaining

8-15 agreement or employment contract, until the expiration of that

8-16 agreement or contract.

8-17 7. As used in this section:

8-18 (a) "Condition relating to mental health" means a condition or

8-19 disorder involving mental illness that falls within any of the diagnostic

8-20 categories listed in the section on mental disorders in the International

8-21 Classification of Diseases published by the United States Department of

8-22 Health and Human Services.

8-23 (b) "Managed care" has the meaning ascribed to it in NRS 695G.040.

8-24 (c) "Managed care organization" has the meaning ascribed to it in

8-25 NRS 695G.050.

8-26 (d) "Rate, term or condition" means any lifetime or annual limit on

8-27 payments, any requirement concerning deductibles, copayments,

8-28 coinsurance or other forms of cost sharing, any limit on out-of-pocket

8-29 costs or on visits to a provider of treatment, and any other financial

8-30 component of health insurance coverage that affects the insured person.

8-31 Sec. 7. NRS 689C.155 is hereby amended to read as follows:

8-32 689C.155 The commissioner may adopt regulations to carry out the

8-33 provisions of section 6 of this act and NRS 689C.107 to 689C.145,

8-34 inclusive, 689C.156 to 689C.159, inclusive, 689C.165, 689C.183,

8-35 689C.187, 689C.191 to 689C.198, inclusive, 689C.203, 689C.207,

8-36 689C.265, 689C.283, 689C.287, 689C.325, 689C.342 to 689C.348,

8-37 inclusive, 689C.355 and 689C.610 to 689C.980, inclusive, and to ensure

8-38 that rating practices used by carriers serving small employers are consistent

8-39 with those sections, including regulations that:

9-1 1. Ensure that differences in rates charged for health benefit plans by

9-2 such carriers are reasonable and reflect only differences in the designs of

9-3 the plans, the terms of the coverage, the amount contributed by the

9-4 employers to the cost of coverage and differences based on the rating

9-5 factors established by the carrier.

9-6 2. Prescribe the manner in which characteristics may be used by such

9-7 carriers.

9-8 Sec. 8. NRS 689C.156 is hereby amended to read as follows:

9-9 689C.156 1. As a condition of transacting business in this state with

9-10 small employers, a carrier shall actively market to a small employer each

9-11 health benefit plan which is actively marketed in this state by the carrier to

9-12 any small employer in this state. The health insurance plans marketed

9-13 pursuant to this section by the carrier must include, without limitation, a

9-14 basic health benefit plan and a standard health benefit plan. A carrier shall

9-15 be deemed to be actively marketing a health benefit plan when it makes

9-16 available any of its plans to a small employer that is not currently receiving

9-17 coverage under a health benefit plan issued by that carrier.

9-18 2. A carrier shall issue to a small employer any health benefit plan

9-19 marketed in accordance with this section if the eligible small employer

9-20 applies for the plan and agrees to make the required premium payments and

9-21 satisfy the other reasonable provisions of the health benefit plan that are not

9-22 inconsistent with NRS 689C.015 to 689C.355, inclusive, and section 6 of

9-23 this act, and NRS 689C.610 to 689C.980, inclusive, except that a carrier is

9-24 not required to issue a health benefit plan to a self-employed person who is

9-25 covered by, or is eligible for coverage under, a health benefit plan offered

9-26 by another employer.

9-27 Sec. 9. NRS 695B.180 is hereby amended to read as follows:

9-28 695B.180 A contract for hospital, medical or dental services must not

9-29 be entered into between a corporation proposing to furnish or provide any

9-30 one or more of the services authorized under this chapter and a subscriber:

9-31 1. Unless the entire consideration therefor is expressed in the contract.

9-32 2. Unless the times at which the benefits or services to the subscriber

9-33 take effect and terminate are stated in a portion of the contract above the

9-34 evidence of its execution.

9-35 3. If the contract purports to entitle more than one person to benefits or

9-36 services, except for family contracts issued under NRS 695B.190, group

9-37 contracts issued under NRS 695B.200, and blanket contracts issued under

9-38 NRS 695B.220.

9-39 4. Unless every printed portion and any endorsement or attached

9-40 papers are plainly printed in type of which the face is not smaller than 10

9-41 points.

10-1 5. Except for group contracts and blanket contracts issued under NRS

10-2 695B.220, unless the exceptions of the contract are printed with greater

10-3 prominence than the benefits to which they apply.

10-4 6. Except for group contracts and blanket contracts issued under NRS

10-5 695B.230, unless, if any portion of the contract purports, by reason of the

10-6 circumstances under which an illness, injury or disablement is incurred to

10-7 reduce any service to less than that provided for the same illness, injury or

10-8 disablement incurred under ordinary circumstances, that portion is printed

10-9 in boldface type and with greater prominence than any other text of the

10-10 contract.

10-11 7. If the contract contains any provisions purporting to make any

10-12 portion of the charter, constitution or bylaws of a nonprofit corporation a

10-13 part of the contract unless that portion is set forth in full in the contract.

10-14 8. Unless the contract, if it is a group contract, contains a provision for

10-15 benefits payable for expenses incurred for the treatment of [the] :

10-16 (a) The abuse of alcohol or drugs, as provided in NRS 695B.194 [.] ;

10-17 and

10-18 (b) Conditions relating to mental health, as provided in section 3 of

10-19 this act.

10-20 9. Unless the contract provides benefits for expenses incurred for

10-21 hospice care.

10-22 10. Unless the contract for service in a hospital contains in blackface

10-23 type, not less than 10 points, the following provisions:

10-24 This contract does not restrict or interfere with the right of any

10-25 person entitled to service and care in a hospital to select the

10-26 contracting hospital or to make a free choice of his attending

10-27 physician, who must be the holder of a valid and unrevoked

10-28 physician’s license and a member of, or acceptable to, the attending

10-29 staff and board of directors of the hospital in which the services are to

10-30 be provided.

10-31 Sec. 10. NRS 695C.170 is hereby amended to read as follows:

10-32 695C.170 1. Every enrollee residing in this state is entitled to

10-33 evidence of coverage under a health care plan. If the enrollee obtains

10-34 coverage under a health care plan through an insurance policy, whether by

10-35 option or otherwise, the insurer shall issue the evidence of coverage.

10-36 Otherwise, the health maintenance organization shall issue the evidence of

10-37 coverage.

10-38 2. Evidence of coverage or amendment thereto must not be issued or

10-39 delivered to any person in this state until a copy of the form of the evidence

10-40 of coverage or amendment thereto has been filed with and approved by the

10-41 commissioner.

11-1 3. An evidence of coverage:

11-2 (a) Must not contain any provisions or statements which are unjust,

11-3 unfair, inequitable, misleading, deceptive, which encourage

11-4 misrepresentation or which are untrue, misleading or deceptive as defined

11-5 in subsection 1 of NRS 695C.300; and

11-6 (b) Must contain a clear and complete statement, if a contract, or a

11-7 reasonably complete summary if a certificate, of:

11-8 (1) The health care services and the insurance or other benefits, if

11-9 any, to which the enrollee is entitled under the health care plan;

11-10 (2) Any limitations on the services, kind of services, benefits, or kind

11-11 of benefits, to be provided, including any deductible or copayment feature;

11-12 (3) Where and in what manner the services may be obtained;

11-13 (4) The total amount of payment for health care services and the

11-14 indemnity or service benefits, if any, which the enrollee is obligated to pay;

11-15 and

11-16 (5) A provision for benefits payable for expenses incurred for the

11-17 treatment of [the] :

11-18 (I) The abuse of alcohol or drugs, as provided in NRS 695C.174 [.]

11-19 ; and

11-20 (II) Conditions relating to mental health, as provided in section 3

11-21 of this act.

11-22 Any subsequent change may be evidenced in a separate document issued to

11-23 the enrollee.

11-24 4. A copy of the form of the evidence of coverage to be used in this

11-25 state and any amendment thereto is subject to the requirements for filing

11-26 and approval of subsection 2 unless it is subject to the jurisdiction of the

11-27 commissioner under the laws governing health insurance, in which event

11-28 the provisions for filing and approval of those laws apply. To the extent

11-29 that such provisions do not apply to the requirements in subsection 3, such

11-30 provisions are amended to incorporate the requirements of subsection 3 in

11-31 approving or disapproving an evidence of coverage required by subsection

11-32 2.

11-33 Sec. 11. NRS 689B.600 is hereby repealed.

11-34 Sec. 12. This act becomes effective on July 1, 1999.

 

11-35 TEXT OF REPEALED SECTION

 

11-36 689B.600 Insurance for groups of 51 persons or more which offers

11-37 medical and surgical benefits and mental health benefits: Aggregate

11-38 lifetime and annual limits on benefits. [Expires by limitation on

11-39 September 30, 2001.]

12-1 1. Except as otherwise provided in this section, if group health

12-2 insurance for groups of 51 persons or more which is issued or delivered for

12-3 issuance in this state and which offers both medical and surgical benefits

12-4 and mental health benefits:

12-5 (a) Does not include an aggregate lifetime limit on substantially all

12-6 medical and surgical benefits, the group health insurance may not impose

12-7 an aggregate lifetime limit on the mental health benefits.

12-8 (b) Includes an aggregate lifetime limit on substantially all medical and

12-9 surgical benefits, the aggregate lifetime limit on the mental health benefits

12-10 offered by the group health insurance must not be less than the aggregate

12-11 lifetime limit set for the medical and surgical benefits.

12-12 (c) Includes no aggregate lifetime limits, or different aggregate lifetime

12-13 limits, on different categories of medical and surgical benefits, the

12-14 applicable aggregate lifetime limit that must be applied in accordance with

12-15 paragraph (b) to the mental health benefits of the group health insurance

12-16 must be computed by taking into account the weighted average of the

12-17 aggregate lifetime limits applicable to such categories of medical and

12-18 surgical benefits offered by the group health insurance. The computation of

12-19 the aggregate lifetime limit must be consistent with the rules adopted by the

12-20 Secretary of the United States Department of Labor pursuant to 29 U.S.C. §

12-21 1185a.

12-22 2. Except as otherwise provided in this section, if group health

12-23 insurance for groups of 51 persons or more which is issued or delivered for

12-24 issuance in this state and which offers both medical and surgical benefits

12-25 and mental health benefits:

12-26 (a) Does not include an annual limit on substantially all medical and

12-27 surgical benefits, the group health insurance may not impose an annual

12-28 limit on the mental health benefits.

12-29 (b) Includes an annual limit on substantially all medical and surgical

12-30 benefits, the annual limit on the mental health benefits offered by the group

12-31 health insurance must not be less than the annual limit set for the medical

12-32 and surgical benefits.

12-33 (c) Includes no annual limit, or different annual limits, on different

12-34 categories of medical and surgical benefits, the applicable annual limit that

12-35 must be applied in accordance with paragraph (b) to the mental health

12-36 benefits of the group health insurance must be computed by taking into

12-37 account the weighted average of the annual limits applicable to such

12-38 categories of medical and surgical benefits offered by the group health

12-39 insurance. The computation of the annual limit must be consistent with the

12-40 rules adopted by the Secretary of the United States Department of Labor

12-41 pursuant to 29 U.S.C. § 1185a.

13-1 3. Nothing in this section:

13-2 (a) Requires group health insurance to provide mental health benefits.

13-3 (b) Except as specifically provided in subsection 1, affects the terms or

13-4 conditions of group health insurance that provides mental health benefits,

13-5 relating to the amount, duration or scope of those benefits, including, but

13-6 not limited to, cost sharing, limits on numbers of visits or days of coverage

13-7 and requirements relating to medical necessity.

13-8 4. Group health insurance is not required to comply with the provisions

13-9 of this section if the application of this section would result in an increase

13-10 in the cost under the group health insurance of 1 percent or more.

13-11 5. If the group health insurance offers a participant or beneficiary more

13-12 than one benefit package option, the provisions of this section must be

13-13 applied separately to each such option offered.

13-14 6. As used in this section:

13-15 (a) "Aggregate lifetime limit" means a limitation on the total amount of

13-16 benefits that may be paid with respect to those benefits under group health

13-17 insurance with respect to a policyholder or other coverage unit.

13-18 (b) "Annual limit" means a limitation on the total amount of benefits

13-19 that may be paid with respect to those benefits in a 12-month period under

13-20 group health insurance with respect to an individual or other coverage unit.

13-21 (c) "Medical and surgical benefits" means benefits, as defined under the

13-22 group health insurance, provided by such insurance for medical or surgical

13-23 services. The term does not include benefits for services relating to mental

13-24 health.

13-25 (d) "Mental health benefits" means benefits, as defined under the group

13-26 health insurance, provided by such insurance for services relating to mental

13-27 health. The term does not include benefits provided for the treatment of

13-28 substance abuse or chemical dependency.

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