Mental Health Parity

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  Mental Health Resources  Federal Guaranteed Issue Medical Plans Mr. Mip

California Mental Health Insurance Parity AB 88 -- CA Insurance Code §10144.5.(a) Every policy of disability insurance that covers hospital, medical, or surgical expenses in this state* ... shall provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and of serious emotional disturbances of a child, ... under the same terms and conditions applied to other medical conditions,

Please note though that this law only requires that if you ALREADY have coverage, it must provide equal benefits.  The law doesn't require that an Individual Plan take someone with these underwriting issues.  If you're eligible under an Employer Group plan, that would generally be guaranteed issue.  You might also check HIPAA, COBRA,Mr. Mip  and our Guaranteed Issue Page.

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for the other members of your family

(b) These benefits shall include the following:
   (1) Outpatient services.
   (2) Inpatient hospital services.
   (3) Partial hospital services.
   (4) Prescription drugs, if the policy or contract includes     coverage for prescription drugs.

   (c) The terms and conditions applied to the benefits required by this section that shall be applied equally to all benefits under the disability insurance policy shall include, but not be limited to, the following:
   (1) Maximum lifetime benefits.
(2) Co-payments and coinsurance.
(3) Individual and family deductibles
.
   (d) For the purposes of this section, "severe mental illnesses" shall include:
   (1) Schizophreniaschizophrenia.com/
   (2) Schizoaffective disorder.
   (3) Bipolar disorder (manic-depressive illness). bipolar.com/
   (4) Major depressive disorders.
   (5) Panic disorder.
   (6) Obsessive-compulsive disorder.
   (7) Pervasive developmental disorder or autism.
   (8) Anorexia nervosa.
   (9) Bulimia nervosa.
   (e) For the purposes of this section, a child suffering from, "serious emotional disturbances of a child" shall be defined as a child who (1) has one or more mental disorders as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders,  other than a primary substance use disorder or developmental disorder, that result in behavior inappropriate to the child's age according to expected developmental norms, and ... (g) This section shall not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, dental-only, or vision-only insurance policies.
View the entire code §10144.5.

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California mental health care parity law, requiring health insurance policies to cover treatment for mental illness on same terms and conditions applied to other medical conditions, applied to health plan beneficiary who did not live in or seek medical care in California, even assuming that parity law applied to policies written to cover expenses incurred in California, inasmuch as plan was written to provide benefits to California beneficiaries, and did not limit its application on basis of where individual beneficiaries lived or sought medical care. Thompkins v. BC Life and Health Ins. Co., C.D.Cal.2006, 414 F.Supp.2d 953

 

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