§ 23-79-141 — Children's Preventive Health Care Act

(a) Title. This section shall be known and may be cited as the "Children's Preventive Health Care Act". (b) Declaration of Purposes. The purpose of this section is to assure that all children eighteen (18) years of age and younger are provided with insurance coverage for preventive healthcare services during their formative years in order to facilitate early detection and prevention of physical and mental illness, thereby avoiding the risks of the extreme costs associated with many preventable childhood diseases. In addition to improving the health of children, providing insurance coverage for children's preventive healthcare services enhances the care-giving skills of parents and helps strengthen the family unit. Providing insurance coverage for children's preventive health care will also reduce the disruption to the emotional and financial well-being of families that often accompanies physical and mental illness among children. (c) Definitions. As used in this section: (1) "Children's preventive healthcare services" means physician-delivered or physician-supervised services for eligible dependents from birth through eighteen (18) years of age, with periodic preventive care visits, including medical history, physical examination, developmental assessment, anticipatory guidance, and appropriate immunizations and laboratory tests, in keeping with prevailing medical standards for the purposes of this section; and (2) "Periodic preventive care visits" means the routine tests and procedures for the purpose of detection of abnormalities or malfunctions of bodily systems and parts according to accepted medical practice. (d) Applicability. (1) Every accident and health insurer, hospital or medical service corporation, health maintenance organization, fraternal benefit society, and self-insured plan transacting accident and health insurance or providing accident and health coverage in this state that delivers, issues for delivery in this state, or renews, extends, or modifies accident and health policies, contracts, certificates, and plans providing hospital and medical coverage on an expense-incurred, service, or prepaid basis, which contracts provide coverage for a family member of the insured person, shall provide to the contract holder coverage for periodic preventive care visits for covered persons from the moment of birth through eighteen (18) years of age. (2) This section does not apply to disability income, specified disease, medicare supplement, hospital indemnity, or accident-only policies. (e) Coverage. (1) Each accident and health insurance policy, contract, certificate, or plan providing benefits for children's preventive healthcare services on a periodic basis shall include twenty (20) visits at approximately the following age intervals: (A) Birth; (B) Two (2) weeks; (C) Two (2) months; (D) Four (4) months; (E) Six (6) months; (F) Nine (9) months; (G) Twelve (12) months; (H) Fifteen (15) months; (I) Eighteen (18) months; (J) Two (2) years; (K) Three (3) years; (L) Four (4) years; (M) Five (5) years; (N) Six (6) years; (O) Eight (8) years; (P) Ten (10) years; (Q) Twelve (12) years; (R) Fourteen (14) years; (S) Sixteen (16) years; and (T) Eighteen (18) years. (2) An accident and health insurance policy, contract, certificate, or plan may provide that children's preventive healthcare services that are rendered during a periodic review shall only be covered to the extent that those services are provided by or under the supervision of a single physician during the course of one (1) visit. (f) Reimbursement, Coinsurance, and Deductibles. (1) The benefits that are mandated by this section shall be reimbursed at levels established by the Insurance Commissioner. (2) (A) Benefits for recommended immunization services shall be exempt from any copayment, coinsurance, deductible, or dollar limit provisions in the accident and health insurance policy. This exemption shall be explicitly stated in the policy. (B) All other children's preventive healthcare services will be subject to copayment, coinsurance, deductible, or dollar limit provisions in the accident and health insurance policy.

Legislative History

Acts 1989, No. 860, § 1; 1995, No. 685, § 1; 2001, No. 1604, §§ 105, 106, 107; 2011, No. 760, § 14.