§431:10A-120  Medical foods and low-proteinmodified food products; treatment of inborn error of metabolism; notice.  (a) Each policy of accident and health or sickness insurance, other than lifeinsurance, disability income insurance, and long-term care insurance, issued orrenewed in this State, each employer group health policy, contract, plan, oragreement issued or renewed in this State, all accident and health or sicknessinsurance policies issued or renewed in this State, all policies providing familycoverages as defined in section 431:10A-103, and all policies providingreciprocal beneficiary family coverage as defined in section 431:10A-601, shallcontain a provision for coverage for medical foods and low-protein modifiedfood products for the treatment of an inborn error of metabolism for itspolicyholders or dependents of the policyholder in this State; provided thatthe medical food or low-protein modified food product is:

(1)  Prescribed as medically necessary for thetherapeutic treatment of an inborn error of metabolism; and

(2)  Consumed or administered enterally under thesupervision of a physician or osteopathic physician licensed under chapter 453.

Coverage shall be for at least eighty per cent ofthe cost of the medical food or low-protein modified food product prescribedand administered pursuant to this subsection.

(b)  Every insurer shall provide notice to itspolicyholders regarding the coverage required by this section.  The noticeshall be in writing and prominently placed in any literature or correspondencesent to policyholders and shall be transmitted to policyholders during calendaryear 2000 when annual information is made available to policyholders, or in anyother mailing to policyholders, but in no case later than December 31, 2000.

(c)  For the purposes of this section:

"Inborn error of metabolism" means adisease caused by an inherited abnormality of the body chemistry of a personthat is characterized by deficient metabolism, originating from congenitaldefects or defects arising shortly after birth, of amino acid, organic acid,carbohydrate, or fat.

"Low-protein modified food product"means a food product that:

(1)  Is specially formulated to have less than onegram of protein per serving;

(2)  Is prescribed or ordered by a physician orosteopathic physician as medically necessary for the dietary treatment of aninborn error of metabolism; and

(3)  Does not include a food that is naturally low inprotein.

"Medical food" means a food that isformulated to be consumed or administered enterally under the supervision of aphysician or osteopathic physician and is intended for the specific dietarymanagement of a disease or condition for which distinctive nutritionalrequirements, based on recognized scientific principles, are established bymedical evaluation. [L 1999, c 86, §2; am L 2002, c 155, §58; am L 2003, c 212,§76; am L 2009, c 11, §50]

 

Note

 

  The 2009 amendment is retroactive to April 3, 2008.  L 2009,c 11, §76(2).