§ 23-79-703 - Health insurance coverage for medically necessary foods.
23-79-703. Health insurance coverage for medically necessary foods.
(a) All health plans issued, delivered, amended, or modified on or after January 1, 2000, shall provide the minimum benefits set out in subsection (b) of this section for medical foods and low protein modified food products for the treatment of a covered person inflicted with phenylketonuria, galactosemia, organic acidemias, and disorders of amino acid metabolism if:
(1) The medical food or low protein modified food products are prescribed as medically necessary for the therapeutic treatment of phenylketonuria, galactosemia, organic acidemias, and disorders of amino acid metabolism;
(2) The products are administered under the direction of a physician licensed under 17-95-401 et seq.; and
(3) The cost of the medical food or low protein modified food products for an individual or a family with a dependent person or persons exceeds the income tax credit of two thousand four hundred dollars ($2,400) per year per person allowed under 23-79-702.
(b) (1) Every health insurance policy, contract, certificate, or health care plan issued in this state by an insurance company, hospital medical service corporation, or health maintenance organization, other than coverage limited to expenses from accident only, specified disease, hospital indemnity, medicare supplement, long-term care, disability income, or other limited benefit health insurance policies, whether an individual or group policy, contract, certificate, or health care plan, that covers the insured and members of the insured's family shall provide coverage for amino acid modified preparations, low protein modified food products, and any other special dietary products and formulas prescribed under the direction of a physician for the therapeutic treatment of phenylketonuria, galactosemia, organic acidemias, and disorders of amino acid metabolism.
(2) This benefit may be subject to a deductible, copayments, coinsurance, or other patient cost-sharing amounts required by the health plan.
(c) If the cost of the medical food or low protein modified food products for an individual or a family with a dependent child or children exceeds the income tax credit of two thousand four hundred dollars ($2,400) per year per child allowed under 23-79-702 and the individual or a family with a dependent child or children has been denied accident and health insurance or coverage for phenylketonuria, galactosemia, organic acidemias, and disorders of amino acid metabolism or cannot afford insurance coverage for phenylketonuria, galactosemia, organic acidemias, and disorders of amino acid metabolism, the Department of Health shall reimburse the provider up to one thousand dollars ($1,000) per individual from any funds appropriated therefor for the required health care service, including screening, diagnostic, and treatment services.