§ 24-A §4256 — Coverage for medically necessary infant formula (REALLOCATED FROM TITLE 24-A, SECTION 4254)

Maine § 24-A §4256

• Jurisdiction: Maine
• Title 24-A: MAINE INSURANCE CODE
• Ch. 56: HEALTH MAINTENANCE ORGANIZATIONS

Text

All individual and group health maintenance organization policies, contracts and certificates must provide coverage for amino acid-based elemental infant formula for children 2 years of age and under in accordance with this section.
1.
Determination of medical necessity.
Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has submitted documentation that the amino acid-based elemental infant formula is medically necessary health care as defined in section 4301‑A, subsection 10‑A, that the amino acid-based elemental infant formula is the predominant source of nutritional intake at a rate of 50% or greater and that other commercial infant formulas, including cow milk-based and soy milk-based formulas have been tried and have failed or are contraindicated. A licensed physician may be required to confirm and document ongoing medical necessity at least annually.
2.
Method of delivery.
Coverage for amino acid-based elemental infant formula must be provided without regard to the method of delivery of the formula.
3.
Required diagnosis.
Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has diagnosed and through medical evaluation has documented one of the following conditions:
4.
Health savings accounts.
Coverage for amino acid-based elemental infant formula under a health insurance policy, contract or certificate issued in connection with a health savings account as authorized under Title XII of the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003 may be subject to the same deductible and out-of-pocket limits that apply to overall benefits under the policy, contract or certificate.

Legislative History

PL 2007, c. 695, Pt. C, §16 (RAL).