Payment and Proceeds

Cal. INS § 10177

California Statutes

(

a) A self-insured employee welfare benefit plan may provide for payment of professional mental health expenses upon a reimbursement basis, or for the exclusion of those services, and provision may be made therein for payment of all or a portion of the amount of charge for those services without requiring that the employee first pay those expenses. The plan shall not prohibit the employee from selecting any psychologist who is the holder of a certificate issued under

Section of the Business and Professions Code or, upon referral by a physician and surgeon licensed under

Section of the Business and Professions Code, any licensed clinical social worker who is the holder of a license issued under

Section of the Business and Professions Code or any marriage and family therapist who is the holder of a certificate or license under

Section 4980.50 of the Business and Professions Code, any professional clinical counselor who is the holder of a license under

Chapter 16 (commencing with

Section 4999.10) of Division of the Business and Professions Code, or any registered nurse licensed pursuant to

Chapter 6 (commencing with

Section 2700) of Division of the Business and Professions Code, who possesses a master’s degree in psychiatric-mental health nursing and is listed as a psychiatric-mental health nurse by the Board of Registered Nursing or any advanced practice registered nurse certified as a clinical nurse specialist pursuant to

Article 9 (commencing with

Section 2838) of

Chapter of Division of the Business and Professions Code who participates in expert clinical practice in the specialty of psychiatric-mental health nursing, to perform the particular services covered under the terms of the plan, the certificate or license holder being expressly authorized by law to perform these services. (

b) Nothing in this

section shall be construed to allow any certificate holder or licensee enumerated in this

section to perform professional services beyond his or her field or fields of competence as established by his or her education, training, and experience. (

c) For the purposes of this section: (1) “Marriage and family therapist” shall mean a licensed marriage and family therapist who has received specific instruction in assessment, diagnosis, prognosis, and counseling, and psychotherapeutic treatment of premarital, marriage, family, and child relationship dysfunctions, which is equivalent to the instruction required for licensure on January 1, 1981. (2) “Professional clinical counselor” means a licensed professional clinical counselor who has received specific instruction in assessment, diagnosis, prognosis, counseling, and psychotherapeutic treatment of mental and emotional disorders, which is equivalent to the instruction required for licensure on January 1, 2012. (

d) A self-insured employee welfare benefit plan, which is issued, renewed, or amended on or after January 1, 1988, that includes mental health services coverage in nongroup contracts may not include a lifetime waiver for that coverage with respect to any employee. The lifetime waiver of coverage provision shall be deemed unenforceable.

Document details

CollectionCalifornia Statutes
CitationCal. INS § 10177
Date2012-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierINS10177.201138139

Payment and Proceeds

Cal. INS § 10177

California Statutes

Payment and Proceeds

Cal. INS § 10177

California Statutes

(

a) A self-insured employee welfare benefit plan may provide for payment of professional mental health expenses upon a reimbursement basis, or for the exclusion of those services, and provision may be made therein for payment of all or a portion of the amount of charge for those services without requiring that the employee first pay those expenses. The plan shall not prohibit the employee from selecting any psychologist who is the holder of a certificate issued under

Section of the Business and Professions Code or, upon referral by a physician and surgeon licensed under

Section of the Business and Professions Code, any licensed clinical social worker who is the holder of a license issued under

Section of the Business and Professions Code or any marriage and family therapist who is the holder of a certificate or license under

Section 4980.50 of the Business and Professions Code, any professional clinical counselor who is the holder of a license under

Chapter 16 (commencing with

Section 4999.10) of Division of the Business and Professions Code, or any registered nurse licensed pursuant to

Chapter 6 (commencing with

Section 2700) of Division of the Business and Professions Code, who possesses a master’s degree in psychiatric-mental health nursing and is listed as a psychiatric-mental health nurse by the Board of Registered Nursing or any advanced practice registered nurse certified as a clinical nurse specialist pursuant to

Article 9 (commencing with

Section 2838) of

Chapter of Division of the Business and Professions Code who participates in expert clinical practice in the specialty of psychiatric-mental health nursing, to perform the particular services covered under the terms of the plan, the certificate or license holder being expressly authorized by law to perform these services. (

b) Nothing in this

section shall be construed to allow any certificate holder or licensee enumerated in this

section to perform professional services beyond his or her field or fields of competence as established by his or her education, training, and experience. (

c) For the purposes of this section: (1) “Marriage and family therapist” shall mean a licensed marriage and family therapist who has received specific instruction in assessment, diagnosis, prognosis, and counseling, and psychotherapeutic treatment of premarital, marriage, family, and child relationship dysfunctions, which is equivalent to the instruction required for licensure on January 1, 1981. (2) “Professional clinical counselor” means a licensed professional clinical counselor who has received specific instruction in assessment, diagnosis, prognosis, counseling, and psychotherapeutic treatment of mental and emotional disorders, which is equivalent to the instruction required for licensure on January 1, 2012. (

d) A self-insured employee welfare benefit plan, which is issued, renewed, or amended on or after January 1, 1988, that includes mental health services coverage in nongroup contracts may not include a lifetime waiver for that coverage with respect to any employee. The lifetime waiver of coverage provision shall be deemed unenforceable.

Document details

CollectionCalifornia Statutes
CitationCal. INS § 10177
Date2012-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierINS10177.201138139