§ 27-41-74 - Enteral nutrition products.
SECTION 27-41-74
§ 27-41-74 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 health maintenanceorganization may impose a copayment and/or deductible for the benefits mandatedby this section, however, in no instance shall the copayment or deductibleamount be greater than the copayment of deductible amount imposed forprescription enteral formulas or nutritional aids. Benefits for services underthis chapter shall be reimbursed in accordance with the respective principlesand mechanisms of reimbursement for each insurer, hospital, or medical servicecorporation, or health maintenance organization. Reimbursement shall beprovided according to the respective principles and policies of the accidentand sickness insurer. Nothing contained in this section precludes the accidentand sickness insurer from conducting managed care, medical necessity, orutilization 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.