Coverage of Treatment of Mental Disorders

  1. Law
  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Coverage of Treatment of Mental Disorders

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  1. As used in this Code section, the term:
    1. "Accident and sickness insurance benefit plan, policy, or contract" means:
      1. An individual accident and sickness insurance policy or contract, as defined in Chapter 29 of this title; or
      2. Any similar individual accident and sickness benefit plan, policy, or contract.
    2. "Mental disorder" shall have the same meaning as defined by The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association) or The International Classification of Diseases (World Health Organization) as of January 1, 1981, or as the Commissioner may further define such term by rule and regulation.
  2. Every insurer authorized to issue accident and sickness insurance benefit plans, policies, or contracts shall be required to make available, either as a part of or as an optional endorsement to all such policies providing major medical insurance coverage which are issued, delivered, issued for delivery, or renewed coverage for the treatment of mental disorders, which coverage shall be at least as extensive and provide at least the same degree of coverage as that provided by the respective plan, policy, or contract for the treatment of other types of physical illnesses. Such an optional endorsement shall also provide that the coverage required to be made available pursuant to this Code section shall also cover the spouse and the dependents of the insured if such insured's spouse and dependents are covered under such benefit plan, policy, or contract. In no event shall such an insurer be required to cover inpatient treatment for more than a maximum of 30 days per policy year or outpatient treatment for more than a maximum of 48 visits per policy year under individual policies.
  3. The optional endorsement required to be made available under subsection (b) of this Code section shall not contain any exclusions, reductions, or other limitations as to coverages, deductibles, or coinsurance provisions which apply to the treatment of mental disorders unless such provisions apply generally to other similar benefits provided or paid for under the accident and sickness insurance benefit plan, policy, or contract.
  4. Nothing in this Code section shall be construed to prohibit an insurer, health care plan, health maintenance organization, or other person issuing any similar accident and sickness insurance benefit plan, policy, or contract from issuing or continuing to issue an accident and sickness insurance benefit plan, policy, or contract which provides benefits greater than the minimum benefits required to be made available under this Code section or from issuing any such plans, policies, or contracts which provide benefits which are generally more favorable to the insured than those required to be made available under this Code section.
  5. Nothing in this Code section shall be construed to prohibit the inclusion of coverage for the treatment of mental disorders that differs from the coverage provided in the same insurance plan, policy, or contract for physical illnesses if the policyholder does not purchase the optional coverage made available pursuant to this Code section.

(Code 1933, § 56-2447, enacted by Ga. L. 1981, p. 896, § 1; Ga. L. 1984, p. 777, § 1; Ga. L. 1989, p. 14, § 33; Ga. L. 1998, p. 736, § 1; Ga. L. 2019, p. 386, § 43/SB 133.)

The 2019 amendment, effective July 1, 2019, in subsection (b), deleted "on or after July 1, 1984," following "or renewed" in the middle of the first sentence, substituted "such insured's spouse" for "the insured's spouse" in the middle of the second sentence; and deleted "nonprofit corporation," following "prohibit an insurer," near the beginning of subsection (d).

Cross references.

- Contents of individual accident and sickness insurance policies, T. 33, C. 29.

Contents of group or blanket accident and sickness insurance, T. 33, C. 30.

Law reviews.

- For article surveying developments in Georgia insurance law from mid-1980 through mid-1981, see 33 Mercer L. Rev. 143 (1981). For review of 1998 legislation relating to insurance, see 15 Georgia St. U.L. Review 170 (1998). For note, "The Parity Cure: Solving Unequal Treatment of Mental Illness Health Insurance Through Federal Legislation," see 44 Ga. L. Rev. 511 (2010).

RESEARCH REFERENCES

ALR.

- What constitutes mental illness or disorder, insanity, or the like, within provision limiting or excluding coverage under health or disability policy, 19 A.L.R.5th 533.


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