MISSISSIPPI LEGISLATURE

1998 Regular Session

To: Public Health and Welfare; Insurance

By: Senator(s) Bean

AN ACT TO REQUIRE ALL INDIVIDUAL AND GROUP HEALTH INSURANCE POLICIES AND PLANS TO PROVIDE COVERAGE FOR DIABETES TREATMENTS; TO REQUIRE HEALTH BENEFIT PLANS TO PROVIDE AN OPTION FOR THE INSURED TO ELECT COVERAGE FOR CHILD IMMUNIZATIONS; AND FOR RELATED PURPOSES. 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. (1) From and after July 1, 1998, all individual and group health insurance policies or plans, pooled risk policies and all other forms of managed/capitated care plans or policies regulated by the State of Mississippi shall provide coverage for diabetes treatments, including, but not limited to, equipment, supplies used in connection with the monitoring of blood glucose and insulin administration, and self-management training/education and medical nutrition therapy in an outpatient, inpatient or home health setting. Coverage for self management training/education and medical nutrition therapy shall not exceed Two Hundred Fifty Dollars ($250.00) in any one-year period. The coverage shall include treatment of all forms of diabetes, including, but not limited to, Type I, Type II, Gestational and all secondary forms of diabetes regardless of mode of treatment if such treatment is prescribed by a health care professional legally authorized to prescribe such treatment and regardless of the age of onset or duration of the disease. Such health insurance plans and policies shall not reduce, eliminate or delay coverage due to the requirements of this act.

(2) The services provided in an outpatient, inpatient or home health setting shall be provided by a Certified Diabetes Educator (CDE), who is appropriately certified, licensed or registered to practice in the State of Mississippi. Medical nutrition therapy shall be provided by a Registered Dietician (RD) appropriately licensed to practice in the State of Mississippi. All services shall be based on nationally recognized standards including, but not limited to, the American Diabetes Association Practice Guidelines.

(3) The benefits provided in this act shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy.

(4) Nothing in this section shall apply to accident only, specified disease, hospital indemnity, Medicare supplement, long-term care, or other limited benefit health insurance policies. The requirements of this section shall be fully applicable to the State Employees Health Insurance Plan and the Public School Employees Health Insurance Plan.

SECTION 2. (1) In this act, "health benefit plan" means a plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident or sickness and that is offered by any insurance company, group hospital service corporation or health maintenance organization that delivers or issues for delivery an individual, group, blanket or franchise insurance policy or insurance agreement, a group hospital service contract, or an evidence of coverage or, to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 USC Section 1001 et seq.), by a multiple employer welfare Security Act of 1974 (29 USC Section 1002), or any other analogous benefit arrangement. The term does not include:

(a) A plan that provides coverage:

(i) Only for a specified disease;

(ii) Only for accidental death or dismemberment;

(iii) For wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; or

(iv) As a supplement to liability insurance.

(b) A Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 USC Section 1395ss);

(c) Workers' compensation insurance coverage;

(d) Medical payment insurance issued as part of a motor vehicle insurance policy;

(e) A long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy meets the definition of a health benefit plan; or

(f) Hospital indemnity insurance coverage.

(2) A health benefit plan that provides benefits for a family member of the insured shall provide an option for the insured to elect coverage for each newly born child of the insured, from birth through the date the child is twenty-four (24) months of age, for:

(a) Immunization against:

(i) Diphtheria;

(ii) Hepatitis B;

(iii) Measles;

(iv) Mumps;

(v) Pertussis;

(vi) Polio;

(vii) Rubella;

(viii) Tetanus;

(ix) Varicella; and

(x) Hemophilus Influenza B (HIB).

(b) Any other immunization that the Commissioner of Insurance determines to be required by law for the child.

(3) The benefits required to be offered under subsection (2) may not be made subject to a deductible, copayment or coinsurance requirement.

(4) This section applies only to a health benefit plan that is delivered, issued for delivery or renewed on or after July 1, 1998. A health benefit plan that is delivered, issued for delivery or renewed before July 1, 1998, is governed by the law as it existed immediately before the effective date of this act, and that law is continued in effect for this purpose. This section is fully applicable to the State Employees Health Insurance Plan and the Public School Employees Health Insurance Plan.

(5) The Commissioner of Insurance shall enforce the provisions of this act.

SECTION 3. This act shall take effect and be in force from and after January 1, 1999.