§ 27-18-70 - Enteral nutrition products.
SECTION 27-18-70
§ 27-18-70 Enteral nutrition products.– (a) Every individual or group health insurance contract, or every individual orgroup hospital or medical expense insurance policy, plan, or group policydelivered, issued for delivery, or renewed in this state on or after January 1,2009, shall provide coverage for nonprescription enteral formulas for home usefor which a physician has issued a written order and which are medicallynecessary for the treatment of malabsorption caused by Crohn's disease,ulcerative colitis, gastroesophageal reflux, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coveragefor inherited diseases of amino acids and organic acids shall include foodproducts modified to be low protein. Provided, however, that coverage shall notexceed an amount of two thousand five hundred dollars ($2,500) per coveredmember per year.
(b) Benefit plans offered by an insurer may impose acopayment and/or deductibles for the benefits mandated by this section,however, in no instance shall the copayment or deductible amount be greaterthan the copayment or deductible amount imposed for prescription enteralformulas or nutritional aids. Benefits for services under this chapter shall bereimbursed in accordance with the respective principles and mechanisms ofreimbursement for each insurer, hospital, or medical service corporation, orhealth maintenance organization. Reimbursement shall be provided according tothe respective principles and policies of the accident and sickness insurer.Nothing contained in this section precludes the accident and sickness insurerfrom conducting managed care, medical necessity, or utilization review.
(c) This section shall not apply to insurance coverageproviding benefits for: (1) hospital confinement indemnity; (2) disabilityincome; (3) accident only; (4) long-term care; (5) Medicare supplement; (6)limited benefit health; (7) specified disease indemnity; (8) sickness or bodilyinjury or death by accident or both; and (9) other limited benefit policies.