Section 031-320-5 - Policies subject to parity requirementsA. Pursuant to Title 24 M.R.S.A., Section2325-A(5-C) and Title 24-A M.R.S.A., Section2843(5-C), all group contracts subject to this Rule, except to the extent they cover employees of employers with 20 or fewer employees, must provide the same level of benefits for the treatment of substance abuse-related disorders as for treatment of physical illnesses.B. With respect to residential treatment, the benefit level must be at least the greater of: (1) The same level of benefits, if any, provided for residential treatment of physical illnesses; or(2) Benefits meeting the following requirements: a. Annual Maximum. The policy must provide residential treatment benefits for substance abuse of at least 30 days per calendar year or, if less, the total number of inpatient days allowed by the policy for all illnesses.b. Coinsurance. The minimum level of benefits provided for residential treatment for substance abuse must be at least 90 percent of the charges or, if less, the percentage applicable to inpatient benefits.c. Maximum Lifetime Residential Benefits. The policy may contain a lifetime maximum limit on the number of covered days for residential treatment of substance abuse of not less than 60 days. This subsection applies only to residential treatment as defined by 24-A M.R.S.A. Section2842(2)(B) that does not also meet the definition of "inpatient services" in 24-A M.R.S.A. Section2843(3)(B). Inpatient services must be covered at the same benefit level as for physical illnesses.
02-031 C.M.R. ch. 320, § 5