Section 031-330-11 - Federal Parity RequirementsThis 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; andb. 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, orb. Include a separate annual dollar maximum for mental illness that is no less than the annual maximum for other illnesses, orc. 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, orb. 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.02-031 C.M.R. ch. 330, § 11