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Current Status Bill Number:View additional legislative information at the LPITS web site.485 Type of Legislation:General Bill GB Introducing Body:Senate Introduced Date:19990211 Primary Sponsor:Rankin All Sponsors:Rankin Drafted Document Number:l:\s-res\lar\012pku .dmb.doc Residing Body:Senate Current Committee:Banking and Insurance Committee 02 SBI Subject:Medical and health insurance, policies to cover treatment for inherited metabolic diseases, medical foods, low protein History Body Date Action Description Com Leg Involved ______ ________ ______________________________________ _______ ____________ Senate 19990211 Introduced, read first time, 02 SBI referred to Committee Versions of This Bill
TO AMEND CHAPTER 71, TITLE 38, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO HEALTH INSURANCE COVERAGE BY ADDING SECTION 38-71-137 SO AS TO REQUIRE AN INSURER TO PROVIDE COVERAGE FOR THE TREATMENT OF INHERITED METABOLIC DISEASES INCLUDING THE MEDICAL FOODS AND LOW PROTEIN MODIFIED FOOD PRODUCTS USED IN THE TREATMENT OF THE DISEASE.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Chapter 71, Title 38 of the 1976 Code is amended by adding:
"Section 38-71-137. (A) All individual and group health insurance and health maintenance organization policies in this State shall include coverage in the policy for the treatment of inherited metabolic diseases including the medical foods and low protein modified food products:
(1) administered under the direction of a physician; and
(2) prescribed as medically necessary for therapeutic treatment of inherited metabolic diseases.
(B) The coverage required to be offered under subsection (A) may not contain any exclusions, reductions, or other limitations as to coverage, deductibles, or coinsurance provisions which apply to that coverage unless these provisions apply generally to other similar benefits provided and paid for under the health insurance policy.
(C) Nothing in this section prohibits a health insurance policy from providing benefits greater than those required to be offered by subsections (A) and (B) or more favorable to the enrollee than those required to be offered by subsections (A) and (B).
(D) This section applies to individual and group health insurance policies issued by a fraternal benefit society, an insurer, a health maintenance organization, or any similar entity, except as exempted by ERISA.
(E) For purposes of this section, the following words have the meanings indicated:
(1) `inherited metabolic disease' means a disease caused by an inherited abnormality of body chemistry.
(2) `inherited metabolic disease' includes a disease for which the state screens newborn babies.
(3) `low protein modified food product' means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease.
(4) `low protein modified food product' does not include a natural food that is naturally low in protein.
(5) `medical food' means a food that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and is formulated to be consumed or administered internally under the direction of a physician.
(F) `Health insurance policy' means a health benefit plan, contract, or evidence of coverage providing health insurance coverage as defined in Section 38-71-670(6) and Section 38-71-840(14)."
SECTION 2. This act takes effect upon approval by the Governor.
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