§ 27-18-66. Tobacco cessation programs.
(a) Every individual or group health insurance contract, plan, or policy delivered, issued
for delivery, or renewed in this state on or after January 1, 2010, that provides
medical coverage that includes coverage for physician services in a physician's office,
and every policy which provides major medical or similar comprehensive-type coverage,
shall include coverage for smoking cessation treatment, provided that if such medical
coverage does not include prescription drug coverage, such contract, plan, or policy
shall not be required to include coverage for FDA approved smoking cessation medications.
(b) As used in this section, smoking cessation treatment includes the use of an over-the-counter
(OTC) or prescription U.S. Food and Drug Administration (FDA) approved smoking cessation
medication when used in accordance with FDA approval, for not more than two (2) courses
of medication of up to fourteen (14) weeks each, annually, when recommended and prescribed
by a prescriber who holds prescriptive privileges in the state in which they are licensed,
and used in combination with an annual outpatient benefit of sixteen (16) one-half
(½) hour evidence-based smoking cessation counseling sessions provided by a qualified
practitioner for each covered individual. Smoking cessation treatment may be redefined
through regulation promulgated by the health insurance commissioner, in accordance
with the most current clinical practice guidelines sponsored by the United States
Department of Health and Human Services or its component agencies.
(c) Health insurance contracts, plans, or policies to which this section applies, may
impose copayments and/or deductibles for the benefits mandated by this section consistent
with the contracts', plans', or policies' copayments and/or deductibles for physician
services and medications. Nothing contained in this section shall impact the reimbursement,
medical necessity or utilization review, managed care, or case management practices
of these health insurance contracts, plans, or policies.
(d) This section shall not apply to insurance coverage providing benefits for:
(1) Hospital confinement indemnity;
(2) Disability income;
(3) Accident only;
(4) Long-term care;
(5) Medicare supplement;
(6) Limited benefit health;
(7) Specified disease indemnity;
(8) Sickness or bodily injury or death by accident or both; and
(9) Other limited benefit policies.