Limitations; review of treatment plan; diagnosis period

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  • (a) The insurer may limit the coverage in the insurance health care plan for behavioral therapy to a yearly benefit of $50,000 for a child who is younger than nine years of age, $35,000 for a child who is at least nine years of age but younger than thirteen years of age and $25,000 for a child who is at least thirteen years of age but younger than twenty-six years of age.

  • (b) Except for treatments and services received by an insured in an inpatient setting, an insure health care center, hospital service corporation, medical service corporation or fraternal benefit society may review a treatment plan developed under section 1732(b) for an insured, in accordance with its utilization review requirements, not more than once every six months unless the insured’s licensed physician, licensed psychologist or licensed clinical social worker agrees that a more frequent review is necessary or changes such insured’s treatment plan.

  • (c) For the purposes of this section, the results of a diagnosis are valid for a period of not less than twelve months, unless the insured’s licensed physician, licensed psychologist or licensed clinical social worker determines a shorter period is appropriate or changes the results of such insured’s diagnosis.


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