The Florida Senate

627.6685  Mental health coverage.--

(1)  DEFINITIONS.--As used in this section, the term:

(a)  "Aggregate lifetime limit" means, with respect to benefits under a group health plan or health insurance coverage, a dollar limitation on the total amount that may be paid with respect to such benefits under the plan or health insurance coverage with respect to an individual or other coverage unit.

(b)  "Annual limit" means, with respect to benefits under a group health plan or health insurance coverage, a dollar limitation on the total amount of benefits that may be paid with respect to such benefits in a 12-month period under the plan or health insurance coverage with respect to an individual or other coverage unit.

(c)  "Medical or surgical benefits" means benefits with respect to medical or surgical services, as defined under the terms of the plan or coverage, but does not include mental health benefits.

(d)  "Mental health benefits" means benefits with respect to mental health services, as defined under the terms of the plan or coverage, but does not include benefits with respect to treatment of substance abuse or chemical dependency.

(e)  "Health insurance coverage" means coverage provided by an authorized insurer or by a health maintenance organization.

(2)  BENEFITS.--

(a)1.  In the case of a group health plan, or health insurance coverage offered in connection with such a plan, which provides both medical and surgical benefits and mental health benefits:

a.  If the plan or coverage does not include an aggregate lifetime limit on substantially all medical and surgical benefits, the plan or coverage may not impose any aggregate lifetime limit on mental health benefits.

b.  If the plan or coverage includes an aggregate lifetime limit on substantially all medical and surgical benefits, the plan or coverage must:

(I)  Apply that applicable lifetime limit both to the medical and surgical benefits to which it otherwise would apply and to mental health benefits and not distinguish in the application of such limit between such medical and surgical benefits and mental health benefits; or

(II)  Not include any aggregate lifetime limit on mental health benefits which is less than that applicable lifetime limit.

c.  For any plan or coverage that is not described in sub-subparagraph a. or sub-subparagraph b. and that includes no or different aggregate lifetime limits on different categories of medical and surgical benefits, the commission shall establish rules under which sub-subparagraph b. is applied to such plan or coverage with respect to mental health benefits by substituting for the applicable lifetime limit an average aggregate lifetime limit that is computed taking into account the weighted average of the aggregate lifetime limits applicable to such categories.

2.  In the case of a group health plan, or health insurance coverage offered in connection with such a plan, which provides both medical and surgical benefits and mental health benefits:

a.  If the plan or coverage does not include an annual limit on substantially all medical and surgical benefits, the plan or coverage may not impose any annual limit on mental health benefits.

b.  If the plan or coverage includes an annual limit on substantially all medical and surgical benefits, the plan or coverage must:

(I)  Apply that applicable annual limit both to medical and surgical benefits to which it otherwise would apply and to mental health benefits and not distinguish in the application of such limit between such medical and surgical benefits and mental health benefits; or

(II)  Not include any annual limit on mental health benefits which is less than the applicable annual limit.

c.  For any plan or coverage that is not described in sub-subparagraph a. or sub-subparagraph b. and that includes no or different annual limits on different categories of medical and surgical benefits, the commission shall establish rules under which sub-subparagraph b. is applied to such plan or coverage with respect to mental health benefits by substituting for the applicable annual limit an average annual limit that is computed taking into account the weighted average of the annual limits applicable to such categories.

(b)  This section may not be construed:

1.  As requiring a group health plan, or health insurance coverage offered in connection with such a plan, to provide any mental health benefits; or

2.  In the case of a group health plan, or health insurance coverage offered in connection with such a plan, which provides mental health benefits, as affecting the terms and conditions, including cost-sharing, limits on numbers of visits or days of coverage, and requirements relating to medical necessity, relating to the amount, duration, or scope of mental health benefits under the plan or coverage, except as specifically provided in paragraph (a) with respect to parity in the imposition of aggregate lifetime limits and annual limits for mental health benefits.

(3)  EXEMPTIONS.--

(a)  This section does not apply to any group health plan, or group health insurance coverage offered in connection with a group health plan, for any plan year of a small employer as defined in s. 627.6699

(b)  This section does not apply with respect to a group health plan, or health insurance coverage offered in connection with a group health plan, if the application of this section to such plan or coverage results in an increase in the cost under the plan or for such coverage of at least 1 percent.

(4)  SEPARATE APPLICATION TO EACH OPTION OFFERED.--For any group health plan that offers a participant or beneficiary two or more benefit-package options under the plan, the requirements of this section apply separately with respect to each such option.

(5)  DURATION.--This section does not apply to benefits for services furnished on or after September 30, 2001.

(6)  CONFLICTING PROVISIONS.--The provisions of this section prevail over any conflicting provision of s. 627.668

History.--s. 12, ch. 98-159; s. 1168, ch. 2003-261.