§ 27-13-7-18 — Inherited metabolic disease coverage

Indiana § 27-13-7-18

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 13: HEALTH MAINTENANCE ORGANIZATIONS
• Ch. 7: Requirements for Group Contracts, Individual Contracts,

Text

(a) As used in this section, "inherited
metabolic disease" means a disease:
(1) caused by inborn errors of amino acid, organic acid, or urea
cycle metabolism; and
(2) treatable by the dietary restriction of one (1) or more amino
acids.
(b) As used in this section, "medical food" means a formula that is:
(1) intended for the dietary treatment of a disease or condition for
which nutritional requirements are established by medical
evaluation; and
(2) formulated to be consumed or administered enterally under
the direction of a physician.
(c) A group health maintenance organization contract that provides
coverage for basic health care services must provide coverage for
medical food that is:
(1) medically necessary; and
(2) prescribed for an enrollee by the enrollee's treating physician
for treatment of the enrollee's inherited metabolic disease.
(d) The coverage that must be provided under this section shall not
be subject to dollar limits, copayments, or deductibles that are less
favorable to an enrollee than the dollar limits, copayments, or
deductibles that apply to coverage for:
(1) prescription drugs generally under the group contract, if
prescription drugs are covered under the group contract; or
(2) physical illness generally under the group contract, if
prescription drugs are not covered under the group contract.

Legislative History

As added by P.L.166-2003, SEC.3.