(a) Benefit classification means the following classifications of medical and surgical benefits and mental health and substance use disorder benefits for purposes of complying with the MHPAEA: inpatient in-network, inpatient out-of-network, outpatient in-network, outpatient out-of-network, emergency care and prescription drugs. Provided, however, the outpatient classification includes any subclassification of office visits.

(b) Comparative analysis means an analysis of the nonquantitative treatment limitations imposed on mental health or substance use disorder benefits to determine if such limitations are comparable to and applied no more stringently than, both as written and in operation, nonquantitative treatment limitations imposed on medical or surgical benefits within the same benefit classification. Comparative analysis includes the documented identification and assessment of the factors, processes, strategies, and evidentiary standards the insurer relied upon to determine the applicability and design of a nonquantitative treatment limitation and the processes and strategies the insurer used in operationalizing a nonquantitative treatment limitation to illustrate insurer compliance with MHPAEA.

(c) Compliance program means a mental health and substance use disorder parity compliance program.

(d) Financial requirements means deductibles, copayments, coinsurance, and out-of-pocket maximums.

(e) Insurer means an insurer authorized to write accident and health insurance in this State, a corporation organized pursuant to Insurance Law article 43, student health plans certified pursuant to Insurance Law section 1124, and municipal cooperative health benefit plans certified pursuant to Insurance Law article 47 and a health maintenance organization certified pursuant to Public Health Law article 44.

(f) Latency period means the period of time that must elapse between the time at which a dose of drug is applied to a biologic system and the time at which a specified pharmacologic effect is produced.

(g) MHPAEA means the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, codified at 29 U.S.C. section 1185a, and its implementing regulations and sub-regulatory guidance.

(h) Nonquantitative treatment limitation means a qualitative limit affecting the scope or duration of benefits such as medical management standards limiting or excluding benefits based on medical necessity, or based on whether the treatment is experimental or investigational; formulary design for prescription drugs; network tier design; standards for provider admission to participate in a network, including reimbursement rates; methods for determining usual, customary, and reasonable charges; fail-first or step therapy protocols; exclusions based on failure to complete a course of treatment; and restrictions based on geographic location, facility type, provider specialty, and other criteria that limit the scope or duration of benefits.

(i) Provider means a physician, health care professional, or facility licensed, registered, certified, or otherwise authorized or accredited as required by State law.

(j) Quantitative treatment limitation means a numerical limit affecting the scope or duration of benefits.