§431:10A-120  Medical foods and low-protein
modified food products; treatment of inborn error of metabolism; notice.  (a) 
Each policy of accident and health or sickness insurance, other than life
insurance, disability income insurance, and long-term care insurance, issued or
renewed in this State, each employer group health policy, contract, plan, or
agreement issued or renewed in this State, all accident and health or sickness
insurance policies issued or renewed in this State, all policies providing family
coverages as defined in section 431:10A-103, and all policies providing
reciprocal beneficiary family coverage as defined in section 431:10A-601, shall
contain a provision for coverage for medical foods and low-protein modified
food products for the treatment of an inborn error of metabolism for its
policyholders or dependents of the policyholder in this State; provided that
the medical food or low-protein modified food product is:



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



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



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



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



(c)  For the purposes of this section:



"Inborn error of metabolism" means a
disease caused by an inherited abnormality of the body chemistry of a person
that is characterized by deficient metabolism, originating from congenital
defects 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 one
gram of protein per serving;



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



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



"Medical food" means a food that is
formulated to be consumed or administered enterally under the supervision of a
physician or osteopathic physician and is intended for the specific dietary
management of a disease or condition for which distinctive nutritional
requirements, based on recognized scientific principles, are established by
medical 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).