Page:United States Statutes at Large Volume 110 Part 4.djvu/103

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PUBLIC LAW 104-204—SEPT. 26, 1996 110 STAT. 2949 taking into account the weighted average of the annual hmits applicable to such categories. "(b) CONSTRUCTION. —Nothing in this section shall be construed— "(1) as requiring a group health plan (or health insurance coverage offered in connection with such a plan) to provide any mental health benefits; or "(2) in the case of a group health plan (or health insurance coverage offered in connection with such a plan) that provides mental health benefits, as affecting the terms and conditions (including cost sharing, limits on numbers of visits or days of coverage, and requirements relating to medical necessity) relating to the amount, duration, or scope of mental health benefits under the plan or coverage, except as specifically provided in subsection (a) (in regard to parity in the imposition of aggregate lifetime limits and annual limits for mental health benefits). "(c) EXEMPTIONS.— "(1) SMALL EMPLOYER EXEMPTION.— This section shall not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) for any plan year of a small employer. "(2) INCREASED COST EXEMPTION. — This section shall not apply with respect to a group health plan (or health insurance coverage offered in connection with a group health plsin) if the application of this section to such plan (or to such coverage) results in an increase in the cost under the plan (or for such coverage) of at least 1 percent. "(d) SEPARATE APPLICATION TO EACH OPTION OFFERED. — In the case of a group health plan that offers a participant or beneficiary two or more benefit package options under the plan, the requirements of this section shall be applied separately with respect to each such option. "(e) DEFINITIONS. —For purposes of this section— "(1) AGGREGATE LIFETIME LIMIT.— The term 'aggregate lifetime limit' means, with respect to benefits under a group health plsin or health insurance coverage, a dollar limitation on the total amount that may be paid with respect to such benefits under the plan or health insurance coverage with respect to an individual or other coverage unit. "(2) ANNUAL LIMIT.— The term 'annual limit' means, with respect to benefits under a group health plan or health insurance coverage, a dollar limitation on the total amount of benefits that may be paid with respect to such benefits in a 12-month period under the plan or health insurance coverage with respect to an individual or other coverage unit. "(3) MEDICAL OR SURGICAL BENEFITS. —The term 'medical or surgical benefits' means benefits with respect to medical or surgical services, as defined under the terms of the plan or coverage (as the case may be), but does not include mental health benefits. "(4) MENTAL HEALTH BENEFITS.— The term 'mental health benefits' means benefits with respect to mental health services, as defined under the terms of the plan or coverage (as the case may be), but does not include benefits with respect to treatment of substance abuse or chemical dependency.