§ 27-20-53 - Tobacco cessation programs.
SECTION 27-20-53
§ 27-20-53 Tobacco cessation programs.– (a) Every individual or group health insurance contract, plan or policydelivered, issued for delivery or renewed in this state on or after January 1,2010, which provides medical coverage that includes coverage for physicianservices in a physician's office, and every policy which provides major medicalor similar comprehensive-type coverage, shall include coverage for smokingcessation treatment, provided that if such medical coverage does not includeprescription drug coverage, such contract, plan or policy shall not be requiredto include coverage for FDA approved smoking cessation medications.
(b) As used in this section, smoking cessation treatmentincludes the use of an over-the-counter (OTC) or prescription US Food and DrugAdministration (FDA) approved smoking cessation medication, when used inaccordance with FDA approval, for not more than two (2) courses of medicationof up to fourteen (14) weeks each, annually, when recommended and prescribed bya prescriber who holds prescriptive privileges in the state in which they arelicensed, and used in combination with an annual outpatient benefit of sixteen(16) one-half (1/2) hour evidence based smoking cessation counseling sessionsprovided by a qualified practitioner for each covered individual. Smokingcessation treatment may be redefined through regulation promulgated by thehealth insurance commissioner in accordance with the most current clinicalpractice guidelines sponsored by the United States department of health andhuman services or its component agencies.
(c) Health insurance contracts, plans, or policies to whichthis section applies, may impose copayments and/or deductibles for the benefitsmandated by this section consistent with the contracts', plans' or policies'copayments and/or deductibles for physician services and medications. Nothingcontained in this section shall impact the reimbursement, medical necessity orutilization review, managed care, or case management practices of these healthinsurance contracts, plans or policies.
(d) This section shall not apply to insurance coverageproviding benefits for:
(1) Hospital confinement indemnity;
(2) Disability income;
(3) Accident only;
(4) Long-term care;
(5) Medicare supplement;
(6) Limited benefit health;
(7) Specified disease indemnity;
(8) Sickness or bodily injury or death by accident or both;and
(9) Other limited benefit policies.