Common use of Behavioral Health Services Clause in Contracts

Behavioral Health Services. Behavioral health services are the evaluation, management, and treatment of a patient with a mental health or substance abuse disorder. For the purposes of this agreement mental health disorder shall be defined as mental illness. Mental illness means: • Any mental disorder and substance abuse disorder that is listed in the most recent revised publication or the most updated volume of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association or the International Classification of Disease Manual (ICO) published by the World Health Organization and that substantially limits the life activities of the person with the illness; • Substance abuse does not include addiction to or abuse of tobacco and/or caffeine; • Mental disorders do not include mental retardation, learning disorders, motor skills disorders, communication disorders, and “V” codes as defined in DSM/IV Diagnostic Criteria published by the American Psychiatric Association. This agreement provides parity in the benefits for behavioral health services. This means that coverage of benefits for mental health and substance abuse disorders is generally comparable to, and not more restrictive than, the benefits for physical health. Financial requirements (such as deductibles or copayments) or quantitative treatment limits (such as visit benefit limits) that apply to behavioral health services within a category (such as inpatient services received from an network provider) are not more restrictive than the benefit limit that applies to most of the medical benefits within that same category.

Appears in 5 contracts

Samples: Subscriber          Agreement, Subscriber Agreement, Subscriber Agreement

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Behavioral Health Services. Behavioral health services are the evaluation, management, and treatment of a patient with a mental health or substance abuse use disorder. For the purposes of this agreement mental health disorder shall be defined as mental illness. Mental illness means: Any mental disorder and substance abuse use disorder that is listed in the most recent revised publication or the most updated volume of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association or the International Classification of Disease Manual (ICO) published by the World Health Organization and that substantially limits the life activities of the person with the illness; Substance abuse use disorder does not include addiction to or abuse of tobacco and/or caffeine; Mental disorders do not include mental retardation, learning disorders, motor skills disorders, communication disorders, and “V” codes as defined in DSM/IV Diagnostic Criteria published by the American Psychiatric Association. This agreement provides parity in the benefits for behavioral health services. This means that coverage of benefits for mental health and substance abuse use disorders is generally comparable to, and not more restrictive than, the benefits for physical health. Financial requirements (such as deductibles or copayments) or quantitative treatment limits (such as visit benefit limits) that apply to behavioral health services within a category (such as inpatient services received from an network provider) are not more restrictive than the benefit limit that applies to most of the medical benefits within that same category.

Appears in 3 contracts

Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement

Behavioral Health Services. Behavioral health services are the evaluation, management, and treatment of a patient with a mental health or substance abuse use disorder. For the purposes of this agreement mental health disorder shall be defined as mental illness. Mental illness means: Any mental disorder and substance abuse use disorder that is listed in the most recent revised publication or the most updated volume of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association or the International Classification of Disease Manual (ICO) published by the World Health Organization and that substantially limits the life activities of the person with the illness; Substance abuse use does not include addiction to or abuse of tobacco and/or caffeine; Mental disorders do not include mental retardation, learning disorders, motor skills disorders, communication disorders, and “V” codes as defined in DSM/IV Diagnostic Criteria published by the American Psychiatric Association. This agreement provides parity in the benefits for behavioral health services. This means that coverage of benefits for mental health and substance abuse use disorders is generally comparable to, and not more restrictive than, the benefits for physical health. Financial requirements (such as deductibles or copayments) or quantitative treatment limits (such as visit benefit limits) that apply to behavioral health services within a category (such as inpatient services received from an network provider) are not more restrictive than the benefit limit that applies to most of the medical benefits within that same category.

Appears in 1 contract

Samples: Subscriber Agreement

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Behavioral Health Services. Behavioral health services are the evaluation, management, and treatment of a patient with a mental health or substance abuse use disorder. For the purposes of this agreement mental health disorder shall be defined as mental illness. Mental illness means: • Any mental disorder and substance abuse use disorder that is listed in the most recent revised publication or the most updated volume of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association or the International Classification of Disease Manual (ICO) published by the World Health Organization and that substantially limits the life activities of the person with the illness; • Substance abuse use disorder does not include addiction to or abuse of tobacco and/or caffeine; • Mental disorders do not include mental retardation, learning disorders, motor skills disorders, communication disorders, and “V” codes as defined in DSM/IV Diagnostic Criteria published by the American Psychiatric Association. This agreement provides parity in the benefits for behavioral health services. This means that coverage of benefits for mental health and substance abuse use disorders is generally comparable to, and not more restrictive than, the benefits for physical health. Financial requirements (such as deductibles or copayments) or quantitative treatment limits (such as visit benefit limits) that apply to behavioral health services within a category (such as inpatient services received from an network provider) are not more restrictive than the benefit limit that applies to most of the medical benefits within that same category.

Appears in 1 contract

Samples: Subscriber                Agreement

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