California Mental Health Insurance Parity AB 88 CA Insurance Code §§10144.5. Health and Safety Code§1374.72 was passed in 1999.
We are not attorney’s but do our best to keep our website visitors informed of the law and Insurance Coverage’s.
So, one must compare AB 88, with the
Insurance Code §10144.5
(a) Every policy of disability (health) insurance that covers hospital, medical, or surgical expenses in this state* … shall provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and of serious emotional disturbances of a child, … under the same terms and conditions applied to other medical conditions,
(b) These benefits shall include the following:
(c) The terms and conditions applied to the benefits required by this section that shall be applied equally to all benefits under the disability (Health, Medical) insurance policy shall include, but not be limited to, the following:
(1) Schizophrenia schizophrenia.com/ WebMD
(2) Schizoaffective disorder. WedMD
(3) Bipolar disorder (manic-depressive illness). bipolar.com/ WebMD
(4) Major depressive disorders. WebMD
(5) Panic disorder. WebMD
(6) Obsessive-compulsive disorder. WebMD
(7) Pervasive developmental disorder WebMD or autism. Web MD
(8) Anorexia nervosa. WebMD
(9) Bulimia nervosa. WebMD
(e) For the purposes of this section, a child suffering from, “serious emotional disturbances of a child” shall be defined as a child who (1) has one or more mental disorders as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, other than a primary substance use disorder or developmental disorder, that result in behavior inappropriate to the child’s age according to expected developmental norms, and … (g) This section shall not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, dental-only, or vision-only insurance policies. §10144.5.
Autism 7.1.2012 SB 946
Consumer Resources & Links
CA Dept. of Managed Health Care on Mental Health Care
NAMI Guide to State Mental Health Parity Laws
NAMI on Parity
NAMI Walk A Thon Fund Raiser
Bazelon Center Paper on Health Reform & Mental Health
Blue Cross Brochures – check the Mental Health Section –
Individual & Family Plan Underwriting Criteria – –AB 88 applies to in force policies – it doesn’t require an Insurance Company to write you.
Sample Requirements for Mental Health Services to be reimbursed by Insurance – Page 17
Sample Response to a website visitors questions.
Sample Research – Reviewing an Insurance Policy and if it would cover LONGER than 50 days in a Psychiatric Hospital.
Guaranteed INDIVIDUAL Medical Coverage – Mr. Mip
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Child Pages in the Mental Health Section
Department of Managed Health Care
Snapshot on Implementation of AB 88 CA Mental Health Parity Law
California Health Care Foundation
California mental health care parity law, requiring health insurance policies to cover treatment for mental illness on same terms and conditions applied to other medical conditions, applied to health plan beneficiary who did not live in or seek medical care in California, even assuming that parity law applied to policies written to cover expenses incurred in California, inasmuch as plan was written to provide benefits to California beneficiaries, and did not limit its application on basis of where individual beneficiaries lived or sought medical care. Thompkins v. BC Life and Health Ins. Co., C.D.Cal.2006, 414 F.Supp.2d 953
Summary: This bill prohibits health plans from basing medical necessity denials on whether the admission for mental health services was voluntary or involuntary, or on the method of transportation of the patient to the health facility. This bill also requires plans that offer mental health services to have information on their website that will assist enrollees in accessing mental health services. SB 1553 §1368.015, §1367.015Health & Safety Code
How to Obtain Behavioral Health Services
the Insurance Gender Nondiscrimination Act (IGNA), also known as AB 1586, prohibits health plans from denying medically necessary health care to transgender individuals insure me kevin.com
FSP – Full Service Partnership dmh.lacounty.gov
California Court of Appeals issued its decision in Marissa Rea v. Blue Shield of California.
The Court held that the California Mental Health Parity Act requires Blue Shield to provide medically necessary treatment for people suffering from severe mental illnesses, including anorexia and bulimia.
The case involved Blue Shield’s denial of residential treatment for the plaintiffs’ eating disorders.
Blue Shield argued that all the Parity Act required was equality of treatment between mental and physical illnesses and, since its policy did not cover residential treatment for physical illnesses, it did not have to provide residential treatment for severe mental illnesses. “This decision confirms that residential treatment is one of the most effective treatments for eating disorders, and must be available to California insureds who need this treatment,” kantor law.net
Please note though that this law only requires that if you ALREADY have coverage, it must provide equal benefits. The law doesn’t require that an Individual Plan take someone with these underwriting issues. If you’re eligible under an Employer Group plan, that would generally be guaranteed issue. You might also check HIPAA, COBRA,Mr. Mip and our Guaranteed Issue Page.