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



(b)  Notwithstanding subsection (a), health
maintenance organizations may establish reasonable provisions for enrollee
cost-sharing so long as the amount the enrollee is required to pay does not
exceed the amount of copayment and deductible customarily required by insurance
policies which are subject to the provisions of this chapter for this type and
level of service.  Nothing in this chapter prevents health maintenance
organizations from establishing durational limits which are actuarially
equivalent to the benefits required by this chapter.  Health maintenance organizations
may limit the receipt of covered services by enrollees to services provided by
or upon referral by providers associated with the health maintenance
organization.



(c)  A health insurance plan shall not impose
rates, terms, or conditions including service limits and financial
requirements, on serious mental illness benefits, if similar rates, terms, or
conditions are not applied to services for other medical or surgical
conditions.  This chapter shall not apply to individual contracts; provided further
that this chapter shall not apply to QUEST medical plans under the department
of 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]