include a beneficiary financial requirement (as 
defined in subparagraph (C)) on substantially 
all medical and surgical benefits within a cat-
egory of items and services (specified in para-
graph (3)(C)), the plan or coverage may not im-
pose such a beneficiary financial requirement on 
mental health or substance-related disorder 
benefits for items and services within such cat-
egory. 
‘‘(B) BENEFICIARY
FINANCIAL
REQUIRE-
MENT.— 
‘‘(i) TREATMENT
OF
DEDUCTIBLES, 
OUT-OF-POCKET LIMITS, AND SIMILAR FI-
NANCIAL REQUIREMENTS.—If the plan or 
coverage includes a deductible, a limitation 
on out-of-pocket expenses, or similar bene-
ficiary financial requirement that does not 
apply separately to individual items and 
services on substantially all medical and 
surgical benefits within a category of items 
and services, the plan or coverage shall 
apply such requirement (or, if there is 
more than one such requirement for such 
category of items and services, the pre-
dominant requirement for such category)
both to medical and surgical benefits with-
in such category and to mental health and 
substance-related disorder benefits within 
such category and shall not distinguish in 
the application of such requirement be-
tween such medical and surgical benefits 
and such mental health and substance-re-
lated disorder benefits. 
‘‘(ii) OTHER
FINANCIAL
REQUIRE-
MENTS.—If the plan or coverage includes a 
beneficiary financial requirement not de-
scribed in clause (i) on substantially all 
medical and surgical benefits within a cat-
egory of items and services, the plan or 
coverage may not impose such financial re-
quirement on mental health or substance- 
related disorder benefits for items and 
services within such category in a way that 
results in greater out-of-pocket expenses to 
the participant or beneficiary than the pre-
dominant beneficiary financial requirement 
applicable to medical and surgical benefits 
for items and services within such cat-
egory.
‘‘(C) BENEFICIARY
FINANCIAL
REQUIRE-
MENT DEFINED.—For purposes of this para-
graph, the term ‘beneficiary financial require-
ment’ includes, with respect to a plan or cov-
erage, any deductible, coinsurance, co-payment, 
other cost sharing, and limitation on the total 
amount that may be paid by a participant or 
beneficiary with respect to benefits under the 
plan or coverage, but does not include the appli-
cation of any aggregate lifetime limit or annual 
limit.’’; and 
(2) in subsection (b)— 
(A) by striking ‘‘construed—’’ and all that 
follows through ‘‘(1) as requiring’’ and insert-
ing ‘‘construed as requiring’’; 
(B) by striking ‘‘; or’’ and inserting a pe-
riod; and 
(C) by striking paragraph (2). 
(b) EXPANSION TO SUBSTANCE-RELATED DISORDER 
BENEFITS AND REVISION OF DEFINITION.—Such section 
is further amended— 
(1) by striking ‘‘mental health benefits’’ each 
place it appears (other than in any provision amend-
ed by paragraph (2)) and inserting ‘‘mental health 
or substance-related disorder benefits’’,
(2) by striking ‘‘mental health benefits’’ each 
place 
it 
appears 
in 
subsections 
(a)(1)(B)(i), 
(a)(1)(C), (a)(2)(B)(i), and (a)(2)(C) and inserting 
‘‘mental health and substance-related disorder bene-
fits’’, and 
(3) in subsection (e), by striking paragraph (4) 
and inserting the following new paragraphs: 
‘‘(4) MENTAL HEALTH BENEFITS.—The term 
‘mental health benefits’ means benefits with respect 
to services for mental health conditions, as defined 
under the terms of the plan and in accordance with 
applicable law, but does not include substance-re-
lated disorder benefits. 
‘‘(5) SUBSTANCE-RELATED
DISORDER
BENE-
FITS.—The term ‘substance-related disorder bene-
fits’ means benefits with respect to services for sub-
stance-related disorders, as defined under the terms 
of the plan and in accordance with applicable law.’’. 
(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 adding at the end the following new para-
graph: 
‘‘(5) AVAILABILITY OF PLAN INFORMATION.— 
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 benefits) shall be made 
available by the plan administrator (or the health in-
surance issuer offering such coverage) in accordance 
with regulations to any current or potential partici-
pant, beneficiary, or contracting provider upon re-
quest. The reason for any denial under the plan (or 
coverage) of reimbursement or payment for services 
with respect to mental health and substance-related 
disorder benefits in the case of any participant or 
beneficiary shall, on request or as otherwise re-
quired, be made available by the plan administrator 
(or the health insurance issuer offering such cov-
erage) to the participant or beneficiary in accord-
ance with regulations.’’. 
(d) 
MINIMUM
BENEFIT
REQUIREMENTS.—Sub-
section (a) of such section is further amended by adding 
at the end the following new paragraph: 
‘‘(6) MINIMUM SCOPE OF COVERAGE AND EQ-
UITY IN OUT-OF-NETWORK BENEFITS.— 
‘‘(A) 
MINIMUM
SCOPE
OF
MENTAL 
HEALTH AND SUBSTANCE-RELATED DISORDER 
BENEFITS.—In the case of a group health plan
(or health insurance coverage offered in connec-
tion with such a plan) that provides any mental 
health or substance-related disorder benefits, 
the plan or coverage shall include benefits for 
any mental health condition or substance-re-
lated disorder included in the most recent edi-
tion of the Diagnostic and Statistical Manual of 
Mental Disorders published by the American 
Psychiatric Association. 
‘‘(B) EQUITY
IN
COVERAGE
OF
OUT-OF- 
NETWORK BENEFITS.— 
‘‘(i) IN GENERAL.—In the case of a 
group health plan (or health insurance cov-
erage offered in connection with such a 
plan) that provides both medical and sur-
gical benefits and mental health or sub-
stance-related disorder benefits, if medical 
and surgical benefits are provided for sub-
stantially all items and services in a cat-
egory specified in clause (ii) furnished out-
side any network of providers established 
or recognized under such plan or coverage, 
the mental health and substance-related 
disorder benefits shall also be provided for 
items and services in such category fur-