376.826. Definitions.
Definitions.
376.826. For the purposes of sections 376.825 to 376.836 the followingterms shall mean:
(1) "Director", the director of the department of insurance, financialinstitutions and professional registration;
(2) "Health insurance policy" or "policy", all health insurance policiesor contracts that are individually underwritten or provide such coverage forspecific individuals and members of their families, which provide for hospitaltreatments. The term shall also include any individually underwrittencoverage issued by a health maintenance organization. The provisions ofsections 376.825 to 376.836 shall not apply to policies which provide coveragefor a specified disease only, other than for mental illness or chemicaldependency;
(3) "Insurer", an entity licensed by the department of insurance,financial institutions and professional registration to offer a healthinsurance policy;
(4) "Mental illness", the following disorders contained in theInternational Classification of Diseases (ICD-9-CM):
(a) Schizophrenic disorders and paranoid states (295 and 297, except297.3);
(b) Major depression, bipolar disorder, and other affective psychoses(296);
(c) Obsessive compulsive disorder, post-traumatic stress disorder andother major anxiety disorders (300.0, 300.21, 300.22, 300.23, 300.3 and309.81);
(d) Early childhood psychoses, and other disorders first diagnosed inchildhood 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 paymentlimits, episodic limits, inpatient or outpatient service limits, andout-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 ofmental illness and physical conditions.
(L. 1999 H.B. 191, A.L. 2004 H.B. 855)Expires 1-01-11