SB3678 Summary

• Requires insurers offering group accident and health policies to provide coverage for diagnosis and medically necessary treatment of mental, emotional, nervous, or substance use disorders based on clinical guidelines including ASAM Criteria, LOCUS, CALOCUS, CASII, and ECSII standards.

• Prohibits insurers from limiting benefits for chronic mental health or substance use disorders to short-term treatment or symptom relief only; requires coverage based on treatment provider recommendations and generally accepted clinical standards.

• Mandates insurers cover out-of-network mental health and substance use disorder services at in-network benefit levels if medically necessary services are unavailable in-network within required geography and timeliness standards.

• Requires both the Department of Insurance and Department of Healthcare and Family Services to each appoint a Mental Health and Substance Use Disorder Parity Compliance Officer and conduct market conduct examinations to ensure compliance with parity requirements.

• Establishes penalties ranging from $100 to $50,000 per violation per beneficiary (capped at $3,000,000 per calendar year) for insurers failing to meet coverage requirements, with amounts adjusted annually for inflation.