POLICY REQUIREMENTS
§ 89.611. Deductibles and copayments.
(a) Definition. A course of treatment shall be considered to be the full range of detoxification, treatment and supportive services carried out specifically to alleviate the dysfunction of the insured or subscriber.
(b) First instance or course of treatment. In the first instance or course of treatment for alcohol abuse and dependency, no deductible or copayment may be less favorable than those applied to similar classes or categories of treatment for other conditions of physical illness or injury.
(c) Second and subsequent courses of treatment. For the second and subsequent courses of treatment for alcohol abuse and dependency, the total proportion of payment after the deductibles and copayments may not be less than 50% of the allowance for similar classes or categories of treatment for other conditions of physical illness or injury.
Authority The provisions of this § 89.611 issued under sections 206, 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S. § § 66, 186, 411 and 412); and The Insurance Company Law of 1921 (40 P. S. § § 341—391).
Source The provisions of this § 89.611 adopted March 25, 1988, effective March 26, 1988, 18 Pa.B. 1360.
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