§ 27-19-61 - Enteral nutrition products.
SECTION 27-19-61
§ 27-19-61 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, gastroespphageal reflux, chronic intestinalpseudo-obstruction, and inherited diseases of amino acids and organic acids.Coverage for inherited diseases of amino acids and organic acids shall includefood products modified to be low protein. Provided, however, that coverageshall not exceed an amount of two thousand five hundred dollars ($2,500) percovered member per year.
(b) Benefit plans offered by a hospital service corporationmay impose a copayment and/or deductible for the benefits mandated by thissection, however, in no instance shall the copayment or deductible amount begreater than the copayment or deductible amount imposed for prescriptionenteral formulas or nutritional aids. Benefits for services under this chaptershall be reimbursed in accordance with the respective principles and mechanismsof reimbursement 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.