Sec. 38a-492c. Coverage for low protein modified food products, amino acid modified preparations and specialized formulas.
Sec. 38a-492c. Coverage for low protein modified food products, amino acid
modified preparations and specialized formulas. (a) For purposes of this section:
(1) "Inherited metabolic disease" includes (A) a disease for which newborn screening is required under section 19a-55; and (B) cystic fibrosis.
(2) "Low protein modified food product" means a product formulated to have less
than one gram of protein per serving and intended for the dietary treatment of an inherited
metabolic disease under the direction of a physician.
(3) "Amino acid modified preparation" means a product intended for the dietary
treatment of an inherited metabolic disease under the direction of a physician.
(4) "Specialized formula" means a nutritional formula for children up to age twelve
that is exempt from the general requirements for nutritional labeling under the statutory
and regulatory guidelines of the federal Food and Drug Administration and is intended
for use solely under medical supervision in the dietary management of specific diseases.
(b) Each individual health insurance policy providing coverage of the type specified
in subdivisions (1), (2), (4), (6), (11) and (12) of section 38a-469 delivered, issued for
delivery or renewed in this state on or after October 1, 1997, shall provide coverage
for amino acid modified preparations and low protein modified food products for the
treatment of inherited metabolic diseases if the amino acid modified preparations or low
protein modified food products are prescribed for the therapeutic treatment of inherited
metabolic diseases and are administered under the direction of a physician.
(c) Each individual health insurance policy providing coverage of the type specified
in subdivisions (1), (2), (4), (6), (11) and (12) of section 38a-469 delivered, issued for
delivery or renewed in this state on or after October 1, 2007, shall provide coverage for
specialized formulas when such specialized formulas are medically necessary for the
treatment of a disease or condition and are administered under the direction of a physician.
(d) Such policy shall provide coverage for such preparations, food products and
formulas on the same basis as outpatient prescription drugs.
(P.A. 97-167, S. 1; P.A. 01-101, S. 1; P.A. 04-173, S. 1: P.A. 07-197, S. 1.)
History: P.A. 01-101 defined, in new Subsec. (a)(4), and added coverage, in new Subsec. (c), for specialized formula;
P.A. 04-173 amended Subsec. (a)(1) and (4) to redefine "inherited metabolic disease" to include cystic fibrosis and redefine
"specialized formula" to include formula for children up to age 8, instead of age 3, and added Subsec. (d) to require coverage
on the same basis as for outpatient prescription drugs; P.A. 07-197 amended Subsec. (a)(4) to redefine "specialized formula"
to include formula for children up to age 12, instead of age 8, and amended Subsec. (c) to require coverage to be applicable
to policies delivered, issued for delivery or renewed in this state on or after October 1, 2007.
See Sec. 38a-518c for similar provisions re group policies.