500.3425 Health insurance policy; coverage for intermediate and outpatient care for substance use disorder required; charges, terms, and conditions; reduction of coverage
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500.3425 Health insurance policy; coverage for intermediate and outpatient care for substance use disorder required; charges, terms, and conditions; reduction of coverage; deductibles and copayment provisions; definitions.
Sec. 3425.
(1)Except as otherwise provided in this subsection, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage for intermediate and outpatient care for substance use disorder. This section does not apply to limited classification policies.
(2)Charges, terms, and conditions for the coverage required to be provided under subsection
(1)must not be less favorable than the maximum prescribed for any other comparable service.
(3)The insurer shall not reduce the coverage required to be provided under subsection
(1)by terms or conditions that apply to other items of coverage in a health insurance policy, group or individual. This subsection does not prohibit an insurer from providing in a health insurance policy deductibles and copayment provisions for coverage for intermediate and outpatient care for substance use disorder.
(4)As used in this section:
(a)"Intermediate care" means the use, in a full 24-hour residential therapy setting, or in a partial, less than 24-hour, residential therapy setting, of any or all of the following therapeutic techniques, as identified in a treatment plan for individuals physiologically or psychologically dependent on or abusing alcohol or drugs:
(i)Chemotherapy.
(ii)Counseling.
(iii)Detoxification services.
(iv)Other ancillary services, such as medical testing, diagnostic evaluation, and referral to other services identified in the treatment plan.
(b)"Limited classification policy" means an accident only policy, a limited accident policy, a travel accident policy, or a specified disease policy.
(c)"Outpatient care" means the use, on both a scheduled and a nonscheduled basis, of any or all of the following therapeutic techniques, as identified in a treatment plan for individuals physiologically or psychologically dependent on or abusing alcohol or drugs:
(i)Chemotherapy.
(ii)Counseling.
(iii)Detoxification services.
(iv)Other ancillary services, such as medical testing, diagnostic evaluation, and referral to other services identified in the treatment plan.
(d)"Substance use disorder" means that term as defined in section 100d of the mental health code, 1974 PA 258, MCL 330.1100d.
History: Add. 1980, Act 429, Eff. Jan. 1, 1982 ;-- Am. 2016, Act 276 , Imd. Eff. July 1, 2016
Popular Name: Act 218