tablished or recognized under 
such plan or coverage. 
‘‘(iv) OUTPATIENT, OUT-OF-NET-
WORK.—Items and services fur-
nished on an outpatient basis and 
outside any network of providers 
established or recognized under 
such plan or coverage. 
‘‘(D) TREATMENT
LIMIT
DEFINED.— 
For purposes of this paragraph, the 
term ‘treatment limit’ means, with re-
spect to a plan or coverage, limitation 
on the frequency of treatment, num-
ber of visits or days of coverage, or 
other similar limit on the duration or 
scope of treatment under the plan or 
coverage. 
‘‘(E) 
PREDOMINANCE.—For 
pur-
poses of this subsection, a treatment 
limit or financial requirement with 
respect to a category of items and 
services is considered to be predomi-
nant if it is the most common or fre-
quent of such type of limit or require-
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smartinez on PRODPC61 with BILLS
ment with respect to such category of 
items and services. 
‘‘(4) BENEFICIARY
FINANCIAL
REQUIRE-
MENTS.— 
‘‘(A) NO BENEFICIARY FINANCIAL RE-
QUIREMENT.—If the plan or coverage 
does not include a beneficiary finan-
cial requirement (as defined in sub-
paragraph (C)) on substantially all 
medical and surgical benefits within 
a category of items and services 
(specified under paragraph (3)(C)), 
the plan or coverage may not impose 
such a beneficiary financial require-
ment on mental health and sub-
stance-related disorder benefits for 
items and services within such cat-
egory. 
‘‘(B) BENEFICIARY
FINANCIAL
RE-
QUIREMENT.— 
‘‘(i) 
TREATMENT
OF 
DEDUCTIBLES, OUT-OF-POCKET
LIM-
ITS, 
AND
SIMILAR
FINANCIAL
RE-
QUIREMENTS.—If the plan or cov-
erage includes a deductible, a lim-
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smartinez on PRODPC61 with BILLS
itation on out-of-pocket expenses, 
or similar beneficiary financial 
requirement that does not apply 
separately to individual items and 
services on substantially all med-
ical and surgical benefits within a 
category of items and services (as 
specified in paragraph (3)(C)), the 
plan or coverage shall apply such 
requirement (or, if there is more 
than one such requirement for 
such category of items and serv-
ices, the predominant require-
ment for such category) both to 
medical 
and 
surgical 
benefits 
within such category and to men-
tal health and substance-related 
disorder benefits within such cat-
egory and shall not distinguish in 
the application of such require-
ment between such medical and 
surgical benefits and such mental 
health and substance-related dis-
order benefits. 
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‘‘(ii) OTHER FINANCIAL REQUIRE-
MENTS.—If the plan or coverage 
includes a beneficiary financial 
requirement 
not 
described 
in 
clause (i) on substantially all med-
ical and surgical benefits within a 
category of items and services, 
the plan or coverage may not im-
pose such financial requirement 
on mental health and substance- 
related disorder benefits for items 
and services within such category 
in a way that is more costly to the 
participant or beneficiary than 
the predominant beneficiary fi-
nancial requirement applicable to 
medical and surgical benefits for 
items and services within such 
category. 
‘‘(C) BENEFICIARY
FINANCIAL
RE-
QUIREMENT DEFINED.—For purposes of 
this paragraph, the term ‘beneficiary 
financial requirement’ includes, with 
respect to a plan or coverage, any de-
ductible, 
coinsurance, 
co-payment, 
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smartinez on PRODPC61 with BILLS
other cost sharing, and limitation on 
the total amount that may be paid by 
a participant or beneficiary with re-
spect to benefits under the plan or 
coverage, but does not include the ap-
plication of any aggregate lifetime 
limit or annual limit.’’; and 
(2) in subsection (b)— 
(A) by striking ‘‘construed—’’ and 
all that follows through ‘‘(1) as requir-
ing’’ and inserting ‘‘construed as re-
quiring’’; 
(B) by striking ‘‘; or’’ and insert-
ing a period; and 
(C) by striking paragraph (2). 
(b) EXPANSION TO SUBSTANCE-RELATED DIS-
ORDER
BENEFITS
AND
REVISION
OF
DEFINI-
TION.—Such section is further amended— 
(1) by striking ‘‘mental health bene-
fits’’ and inserting ‘‘mental health and 
substance-related disorder benefits’’ each 
place it appears; and 
(2) in paragraph (4) of subsection 
(e)— 
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smartinez on PRODPC61 with BILLS
(A) by striking ‘‘MENTAL
HEALTH 
BENEFITS’’ 
and 
inserting 
‘‘MENTAL 
HEALTH
AND
SUBSTANCE-RELATED
DIS-
ORDER BENEFITS’’; 
(B) by striking ‘‘benefits with re-
spect to mental health services’’ and 
inserting ‘‘benefits with respect to 
services for mental health conditions 
or substance-related disorders’’; and 
(C) by striking ‘‘, but does not in-
clude benefits with respect to treat-
ment of substances abuse or chemical 
dependency’’. 
(c) AVAILABILITY
OF
PLAN
INFORMATION 
ABOUT
CRITERIA
FOR
MEDICAL
NECESSITY.— 
Subsection (a) of such section, as amended by 
subsection (a)(1), is further amended by add-
ing at the end the following new paragraph: 
‘‘(5) AVAILABILITY
OF
PLAN
INFORMA-
TION.—The criteria for medical necessity 
determinations made under the plan with 
respect to mental health and substance- 
related disorder benefits (or the health 
insurance coverage offered in connection 
with the plan with respect to such bene-
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