(a)All individual and group health insurance policies
providing coverage on an expense incurred basis, individual and
group service or indemnity type contracts issued by any insurer
including any nonprofit corporation and individual and group
service contracts issued by a health maintenance organization or
delivered on or after July 1, 2013, shall provide coverage for
the equipment, supplies and outpatient self-management training
and education, including medical nutrition therapy for the
treatment of inherited enzymatic disorders caused by single gene
defects involved in the metabolism of amino, organic and fatty
acids if prescribed by a health care professional legally
authorized to prescribe such items under law. Covered inherited
enzymatic disorder outpatient self-management training
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(a) All individual and group health insurance policies
providing coverage on an expense incurred basis, individual and
group service or indemnity type contracts issued by any insurer
including any nonprofit corporation and individual and group
service contracts issued by a health maintenance organization or
delivered on or after July 1, 2013, shall provide coverage for
the equipment, supplies and outpatient self-management training
and education, including medical nutrition therapy for the
treatment of inherited enzymatic disorders caused by single gene
defects involved in the metabolism of amino, organic and fatty
acids if prescribed by a health care professional legally
authorized to prescribe such items under law. Covered inherited
enzymatic disorder outpatient self-management training and
education shall be provided by a certified, registered or
licensed health care professional with expertise in inherited
enzymatic disorders. For purposes of this section, required
covered outpatient self-management training and education shall
be limited to:
(i) A one (1) time evaluation and training program
when medically necessary, within one (1) year of diagnosis;
(ii) Additional medically necessary self-management
training shall be provided upon a significant change in
symptoms, condition or treatment.
(b) For purposes of this section, "inherited enzymatic
disorders" includes and is limited to phenylketonuria, maternal
phenylketonuria, maple syrup urine disease, tyrosinemia,
homocystinuria, histidinemia, urea cycle disorders,
hyperlysinemia, glutaric acidemias, methylmalonic acidemia and
propionic acidemia.
(c) The benefits provided under this section shall be
subject to the same annual deductibles or coinsurance
established for all other covered benefits within a given
policy. Private third party payors may not refuse, reduce or
eliminate coverage due to the requirements of this section.
Enforcement of this section shall be performed by the
commissioner or his designee.
(d) This section shall apply to both public and private
health benefit plans, as defined in W.S. 26-1-102(a)(xxxiii) and
(xxxiv), delivered or issued on or after July 1, 2013.
(e) Repealed by Laws 2020, ch. 87, § 3.
ARTICLE 5
prescription eye drop refill coverage