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Section 10177 Of Article 4. Payment And Proceeds From California Insurance Code >> Division 2. >> Part 2. >> Chapter 1. >> Article 4.
10177
. (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 2948 of the Business and Professions
Code or, upon referral by a physician and surgeon licensed under
Section 2135 of the Business and Professions Code, any licensed
clinical social worker who is the holder of a license issued under
Section 4996 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 2 of the
Business and Professions Code, or any registered nurse licensed
pursuant to Chapter 6 (commencing with Section 2700) of Division 2 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 6 of Division 2 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.
(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.
