SUMMARY--Requires policies of health insurance to provide coverage for certain digestive disorders. (BDR 57-23)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State or on Industrial Insurance: No.
EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.
AN ACT relating to insurance; requiring policies of health insurance to provide coverage for certain digestive disorders; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1 Chapter 689A of NRS is hereby amended by adding thereto a new section to read as follows:
1. A policy of health insurance must provide coverage for:
(a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and
(b) Food products, purchased for a person requiring the treatment described in subsection 1, that are modified to be low in protein, but only to the extent of $2,500 annually.
2. The coverage required by subsection 1 must be provided whether or not the condition existed when the policy was purchased.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.
Sec. 2 Chapter 689B of NRS is hereby amended by adding thereto a new section to read as follows:
1. A policy of group health insurance must provide coverage for:
(a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and
(b) Food products, purchased for a person requiring the treatment described in subsection 1, that are modified to be low in protein, but only to the extent of $2,500 annually.
2. The coverage required by subsection 1 must be provided whether or not the condition existed when the policy was purchased.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.
Sec. 3 Chapter 695B of NRS is hereby amended by adding thereto a new section to read as follows:
1. A contract for hospital or medical service must provide coverage for:
(a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and
(b) Food products, purchased for a person requiring the treatment described in subsection 1, that are modified to be low in protein, but only to the extent of $2,500 annually.
2. The coverage required by subsection 1 must be provided whether or not the condition existed when the contract was purchased.
3. A contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the contract or the renewal which is in conflict with this section is void.
Sec. 4 Chapter 695C of NRS is hereby amended by adding thereto a new section to read as follows:
1. A health maintenance plan must provide coverage for:
(a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and
(b) Food products, purchased for a person requiring the treatment described in subsection 1, that are modified to be low in protein, but only to the extent of $2,500 annually.
2. The coverage required by subsection 1 must be provided whether or not the condition existed when the health maintenance plan was purchased.
3. Any evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the evidence of coverage or the renewal which is in conflict with this section is void.