§ 27-19-61. Enteral nutrition products.
(a) Every individual or group health insurance contract, or every individual or group
hospital or medical expense insurance policy, plan, or group policy delivered, issued
for delivery, or renewed in this state on or after January 1, 2009, shall provide
coverage for nonprescription enteral formulas for home use for which a physician has
issued a written order and that are medically necessary for the treatment of malabsorption
caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, chronic intestinal
pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage
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§ 27-19-61. Enteral nutrition products.
(a) Every individual or group health insurance contract, or every individual or group
hospital or medical expense insurance policy, plan, or group policy delivered, issued
for delivery, or renewed in this state on or after January 1, 2009, shall provide
coverage for nonprescription enteral formulas for home use for which a physician has
issued a written order and that are medically necessary for the treatment of malabsorption
caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, chronic intestinal
pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage
for inherited diseases of amino acids and organic acids shall include food products
modified to be low protein and shall extend to all recipients regardless of age.
(b) Benefit plans offered by a hospital service corporation may impose a copayment or
deductible, or both, for the benefits mandated by this section, however, in no instance
shall the copayment or deductible amount be greater than the copayment or deductible
amount imposed for prescription enteral formulas or nutritional aids. Benefits for
services under this chapter shall be reimbursed in accordance with the respective
principles and mechanisms of reimbursement for each insurer, hospital, or medical
service corporation, or health maintenance organization. Reimbursement shall be provided
according to the respective principles and policies of the accident and sickness insurer.
Nothing contained in this section precludes the accident and sickness insurer from
conducting managed care, medical necessity, or utilization review.
(c) 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.