§431M-5  Nondiscrimination in deductibles,copayment plans, and other limitations on payment.  (a)  Deductible orcopayment plans may be applied to benefits paid to or on behalf of patientsduring the course of treatment as described in section 431M-4, but in any casethe proportion of deductibles or copayments shall be not greater than thoseapplied to comparable physical illnesses generally requiring a comparable levelof care in each policy.

(b)  Notwithstanding subsection (a), healthmaintenance organizations may establish reasonable provisions for enrolleecost-sharing so long as the amount the enrollee is required to pay does notexceed the amount of copayment and deductible customarily required by insurancepolicies which are subject to the provisions of this chapter for this type andlevel of service.  Nothing in this chapter prevents health maintenanceorganizations from establishing durational limits which are actuariallyequivalent to the benefits required by this chapter.  Health maintenance organizationsmay limit the receipt of covered services by enrollees to services provided byor upon referral by providers associated with the health maintenanceorganization.

(c)  A health insurance plan shall not imposerates, terms, or conditions including service limits and financialrequirements, on serious mental illness benefits, if similar rates, terms, orconditions are not applied to services for other medical or surgicalconditions.  This chapter shall not apply to individual contracts; provided furtherthat this chapter shall not apply to QUEST medical plans under the departmentof human services until July 1, 2002. [L 1988, c 202, pt of §1, §3; am L 1994,c 111, §4; am L 1998, c 78, §3; am L 1999, c 121, §§3, 6; am L 2000, c 243,§§7, 8(2), 11(2); am L 2002, c 239, §1; am L 2003, c 197, §§3, 4]