House Journal: Page 1373: Thursday, April 11, 2002
47 neurobiological disorders identified in subsection 3.
48 Definitions established by the commissioner shall be
49 consistent with definitions provided in the most
50 recent edition of the American psychiatric
Page 2
1 association's diagnostic and statistical manual of
2 mental disorders, as the definitions may be amended
3 from time to time. The commissioner may adopt the
4 definitions provided in such manual by reference.
5 5. This section shall not apply to accident only,
6 specified disease, short-term hospital or medical,
7 hospital confinement indemnity, credit, dental,
8 vision, Medicare supplement, long-term care, basic
9 hospital and medical-surgical expense coverage as
10 defined by the commissioner, disability income
11 insurance coverage, coverage issued as a supplement to
12 liability insurance, workers' compensation or similar
13 insurance, or automobile medical payment insurance, or
14 individual accident and sickness policies issued to
15 individuals or to individual members of a member
16 association.
17 6. A carrier, organized delivery system, or plan
18 established pursuant to chapter 509A may manage the
19 benefits provided through common methods including,
20 but not limited to, providing payment of benefits or
21 providing care and treatment under a capitated payment
22 system, prospective reimbursement rate system,
23 utilization control system, incentive system for the
24 use of least restrictive and least costly levels of
25 care, a preferred provider contract limiting choice of
26 specific providers, or any other system, method, or
27 organization designed to assure services are medically
28 necessary and clinically appropriate.
29 7. a. A group policy or contract or plan covered
30 under this section shall not impose an aggregate
31 annual or lifetime limit on neurobiological disorder
32 coverage benefits unless the policy or contract or
33 plan imposes an aggregate annual or lifetime limit on
34 substantially all medical and surgical coverage
35 benefits.
36 b. A group policy or contract or plan covered
37 under this section that imposes an aggregate annual or
38 lifetime limit on substantially all medical and
39 surgical coverage benefits shall not impose an
40 aggregate annual or lifetime limit on neurobiological
41 disorder coverage benefits which is less than the
42 aggregate annual or lifetime limit imposed on
43 substantially all medical and surgical coverage
44 benefits.
45 8. A group policy or contract or plan covered
© 2002 Cornell College and
League of Women Voters of Iowa
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