Guam § 28102 - Coverage for Chemical Dependency Treatment.

§ 28102. Coverage for Chemical Dependency Treatment.

(a) As used in this Section, the term >chemical dependency= means the

pathological use or abuse of alcohol or other drugs in a manner, or to a

degree, that produces an impairment in personal, social or occupational

functioning and which may, but need not, include a pattern of tolerance and

withdrawal.

(b) Every insurer that writes a policy or contract of group or blanket

health insurance or group or blanket accident and health insurance that is

issued, renewed or amended on or after January 1, 1999, shall offer to

provide to its insureds benefits for the necessary care and treatment of

chemical dependency that are not less favorable than benefits for physical

illness generally. Except as provided in Subsection (c) of this Section,

benefits for treatment of chemical dependency shall be subject to the same

durational limits, dollar limits, deductibles and coinsurance factors as are

benefits for physical illness generally.

(c) Every group policy or group contract of insurance that provides

benefits for chemical dependency treatment and that provides total annual

benefits for all illnesses in excess of Eight Thousand Dollars ($8,000.00) is

subject to the following conditions:

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(1) the policy or contract shall provide, for each twelve (12)

month period, a minimum benefit of Eight Thousand Dollars

($8,000.00) for the necessary care and treatment of chemical

dependency; and

(2) the policy or contract shall provide a minimum benefit of

Sixteen Thousand Dollars ($16,000.00) for the necessary care and

treatment of chemical dependency for the life of the policy or contract.

(d) Provisions for benefits for necessary care and treatment of chemical

dependency in group policies or group contracts of insurance shall provide

benefit payments for the following providers of necessary care and

treatment of chemical dependency:

(1) Units of a general hospital:

a. chemical dependency units in facilities;

b. medical units;

c. psychiatric units; and

(2) The following facilities or programs:

a. chemical dependency units in psychiatric hospitals;

b. chemical dependency hospitals;

c. residential chemical dependency treatment facilities;

d. social setting detoxification facilities or programs;

e. medical detoxification or programs; and

(3) duly licensed physicians and duly licensed practicing

psychologists and certified professionals working under the direct

supervision of such physicians or psychologists in facilities described

in Items (1) and (2) above, and in day/night programs or outpatient

treatment facilities.

Provided, however, that nothing in this Subsection shall prohibit any

policy or contract of insurance from requiring the most cost effective

treatment setting to be utilized by the person undergoing necessary care and

treatment for chemical dependency.

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(e) Coverage for chemical dependency treatment as described in this

Section shall not be applicable to any group policy holder or group contract

holder who rejects the coverage in writing.