Section 376.826

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 2004, 2 histories, see footnote   (history) 

  376.826.  Definitions. — For the purposes of sections 376.825 to 376.836 the following terms shall mean:

  (1) "Director", the director of the department of insurance, financial institutions and professional registration;

  (2) "Health insurance policy" or "policy", all health insurance policies or contracts that are individually underwritten or provide such coverage for specific individuals and members of their families, which provide for hospital treatments. The term shall also include any individually underwritten coverage issued by a health maintenance organization. The provisions of sections 376.825 to 376.836 shall not apply to policies which provide coverage for a specified disease only, other than for mental illness or chemical dependency;

  (3) "Insurer", an entity licensed by the department of insurance, financial institutions and professional registration to offer a health insurance policy;

  (4) "Mental illness", the following disorders contained in the International Classification of Diseases (ICD-9-CM):

  (a) Schizophrenic disorders and paranoid states (295 and 297, except 297.3);

  (b) Major depression, bipolar disorder, and other affective psychoses (296);

  (c) Obsessive compulsive disorder, post-traumatic stress disorder and other major anxiety disorders (300.0, 300.21, 300.22, 300.23, 300.3 and 309.81);

  (d) Early childhood psychoses, and other disorders first diagnosed in childhood or adolescence (299.8, 312.8, 313.81 and 314);

  (e) Alcohol and drug abuse (291, 292, 303, 304, and 305, except 305.1); and

  (f) Anorexia nervosa, bulimia and other severe eating disorders (307.1, 307.51, 307.52 and 307.53);

  (g) Senile organic psychotic conditions (290); .

  (5) "Rate", "term", or "condition", any lifetime limits, annual payment limits, episodic limits, inpatient or outpatient service limits, and out-of-pocket limits. This definition does not include deductibles, co-payments, or coinsurance prior to reaching any maximum out-of-pocket limit. Any out-of-pocket limit under a policy shall be comprehensive for coverage of mental illness and physical conditions

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(L. 1999 H.B. 191, A.L. 2004 H.B. 855)

Expires 1-1-11