2005 Regular Session
To: Insurance; Public Health and Human Services
By: Representative Bentz
AN ACT TO REQUIRE HEALTH INSURANCE POLICIES TO INCLUDE COVERAGE FOR FORMULA AND LOW PROTEIN MODIFIED FOOD PRODUCTS RECOMMENDED BY A PHYSICIAN FOR THE TREATMENT OF A PATIENT WITH PHENYLKETONURIA OR AN INBORN ERROR OF METABOLISM; TO PROVIDE THAT THE COVERAGE SHALL NOT BE SUBJECT TO ANY GREATER DEDUCTIBLE OR COPAYMENT THAN OTHER SIMILAR HEALTH CARE SERVICES PROVIDED BY THE POLICY, BUT MAY BE SUBJECT TO AN ANNUAL BENEFIT MAXIMUM; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. All individual and group health insurance policies providing coverage on an expense incurred basis, individual and group service or indemnity type contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group arrangements to the extent not preempted by federal law and all managed health care delivery entities of any type or description, that are delivered, issued for delivery, continued or renewed on or after July 1, 2005, and shall provide benefits or coverage for formula and low protein modified food products recommended by a physician for the treatment of a patient with phenylketonuria or an inborn error of metabolism who is covered under the policy. For purposes of this section, "low protein modified food products" means foods that are specifically formulated to have less than one (1) gram of protein per serving and are intended to be used under the direction of a physician for the dietary treatment of any inherited metabolic disease. Low protein modified food products do not include foods that are naturally low in protein. The coverage required by this section shall not be subject to any greater deductible or copayment than other similar health care services provided by the policy, contract or plan, but may be subject to an annual benefit maximum of not less than Five Thousand Dollars ($5,000.00) per covered individual. Nothing in this section shall prohibit a carrier from using individual case management or from contracting with vendors of the formula and food products. This section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, or any other supplemental policy. The Commissioner of Insurance may adopt rules as necessary to implement this section.
SECTION 2. This act shall take effect and be in force from and after July 1, 2005.