Glossary
Constructive Dollar Limit
Health plans can generally set the terms and conditions (such as cost-sharing
and limits on the number of visits or days of coverage) for the amount,
duration, and scope of mental health benefits.
However, a plan may not impose a constructive dollar limit on mental health
benefits that is lower than that for medical/surgical
benefits. A limit on the number of visits coupled with a
maximum dollar amount payable per visit by the plan is a constructive dollar
limit.
Back
Complete Glossary of Terms
|