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96-2466
08/02
HOUSE BILL 1431
AN ACT requiring individual health insurance policies to cover
nonprescription enteral formulas.
SPONSORS: Rep. Nordgren, Graf 10; Rep. B. Packard, Hills
19; Rep. A. Merrill, Straf 8; Sen. Shaheen, Dist 21;
Sen. Fraser, Dist 4
COMMITTEE: Commerce, Small Business, Consumer Affairs and
Economic Development
This bill requires individual health insurance policies
of health insurers, hospital service corporations, medical service
corporations, nonprofit health service corporations, and health
maintenance organizations to cover nonprescription enteral formulas.
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EXPLANATION: Matter added to current law appears in
bold italics.
Matter removed from current law appears in
[brackets].
Matter which is either (a) all new or (b) repealed
and reenacted appears in regular type.
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08/02
131:1 New Section; Individual Policies; Accident or Health
Insurance. Amend RSA 415 by inserting after section 6-b
the following new section:
415:6-c Coverage for Nonprescription Enteral Formulas.
I. Each insurer that issues or renews any individual
policy of accident or health insurance providing benefits for
medical or hospital expenses, shall provide to certificate holders
of such insurance who are residents of this state, coverage for
the provision of nonprescription enteral formulas for the treatment
of impaired absorption of nutrients caused by disorders affecting
the absorptive surface, functional length, or motility of the
gastrointestinal tract. Such coverage shall be provided when
the prescribing physician has issued a written order stating that
the enteral formula is needed to sustain life, is medically necessary,
and is the least restrictive and most cost effective means for
meeting the needs of the patient.
II. Each insurer that issues or renews any individual
policy of accident or health insurance providing benefits for
medical or hospital expenses, shall provide to certificate holders
of such insurance who are residents of this state, coverage for
the provision of nonprescription enteral formulas and food products
required for persons with inherited diseases of amino acids and
organic acids. Such coverage shall be provided when the prescribing
physician has issued a written order stating that the enteral
formula or food product is medically necessary and is the least
restrictive and most cost effective means for meeting the needs
of the patient. Coverage for inherited diseases of amino acids
and organic acids shall, in addition to the enteral formula, include
food products modified to be low protein in an amount not to exceed
$1,800 annually for any insured individual.
III. The benefits included in this section shall
not be subject to any greater deductible than any other benefits
provided by the insurer. The coinsurance required by the enrolled
participant shall not exceed the amount allowed under the contract
for the reasonable and customary charge for the service provided.
131:2 Individual Policies; Accident or Health Insurance.
Amend RSA 415:18-e, II to read as follows:
II. Each insurer that issues or renews any policy
of group or blanket accident or health insurance providing benefits
for medical or hospital expenses, shall provide to each group,
or to the portion of each group comprised of certificate holders
of such insurance who are residents of this state, coverage for
the provision of nonprescription enteral formulas and food products
required for persons with inherited diseases of amino acids and
organic acids. Such coverage shall be provided when the prescribing
physician has issued a written order stating that the enteral
formula or food product is medically necessary and is the least
restrictive and most cost effective means for meeting the needs
of the patient. Coverage for inherited diseases of amino acids
and organic acids shall, in addition to the enteral formula,
include food products modified to be low protein in an amount
not to exceed $1,800 annually for any insured individual.
131:3 Individual Policies; Hospital Service Corporations.
Amend RSA 419:5-f, I and II to read as follows:
I. Every hospital service corporation and every
other similar corporation licensed under the laws of another state
that issues or renews any policy of individual or group blanket
accident or health insurance providing benefits for medical or
hospital expenses, shall provide to each individual or
group, or to the portion of each group comprised of certificate
holders of such insurance who are residents of this state, coverage
for the provision of nonprescription enteral formulas for the
treatment of impaired absorption of nutrients caused by disorders
affecting the absorptive surface, functional length, or motility
of the gastrointestinal tract. Such coverage shall be provided
when the prescribing physician has issued a written order stating
that the enteral formula is needed to sustain life, is medically
necessary, and is the least restrictive and most cost effective
means for meeting the needs of the patient.
II. Every hospital service corporation and every
other similar corporation licensed under the laws of another state
that issues or renews any policy of individual or group blanket
accident or health insurance providing benefits for medical or
hospital expenses, shall provide to each individual or
group, or to the portion of each group comprised of certificate
holders of such insurance who are residents of this state, coverage
for the provision of nonprescription enteral formulas and food
products required for persons with inherited diseases of amino
acids and organic acids. Such coverage shall be provided when
the prescribing physician has issued a written order stating that
the enteral formula or food product is medically necessary and
is the least restrictive and most cost effective means for meeting
the needs of the patient. Coverage for inherited diseases of
amino acids [or] and organic acids shall, in addition
to the enteral formula, include food products modified to
be low protein in an amount not to exceed $1,800 annually for
any insured individual.
131:4 Individual Policies; Medical Service Corporations.
Amend RSA 420:5-g, I and II to read as follows:
I. Every medical service corporation and every
other similar corporation licensed under the laws of another state
that issues or renews any policy of individual or group blanket
accident or health insurance providing benefits for medical or
hospital expenses, shall provide to each individual or
group, or to the portion of each group comprised of certificate
holders of such insurance who are residents of this state, coverage
for the provision of nonprescription enteral formulas for the
treatment of impaired absorption of nutrients caused by disorders
affecting the absorptive surface, functional length, or motility
of the gastrointestinal tract. Such coverage shall be provided
when the prescribing physician has issued a written order stating
that the enteral formula is needed to sustain life, is medically
necessary, and is the least restrictive and most cost effective
means for meeting the needs of the patient.
II. Every medical service corporation and every
other corporation licensed under the laws of another state
that issues or renews any policy of individual or group blanket
accident or health insurance providing benefits for medical or
hospital expenses, shall provide to each individual or
group, or to the portion of each group comprised of certificate
holders of such insurance who are residents of this state, coverage
for the provision of nonprescription enteral formulas and food
products required for persons with inherited diseases of amino
acids and organic acids. Such coverage shall be provided when
the prescribing physician has issued a written order stating that
the enteral formula or food product is medically necessary and
is the least restrictive and most cost effective means for meeting
the needs of the patient. Coverage for inherited diseases of
amino acids [or] and organic acids shall, in addition
to the enteral formula, include food products modified to
be low protein in an amount not to exceed $1,800 annually for
any insured individual.
131:5 Individual Policies; Nonprofit Health Service Corporations.
Amend RSA 420-A:7-i, I and II to read as follows:
I. Every nonprofit health service corporation
and every other similar corporation licensed under the laws of
another state that issues or renews any policy of individual
or group blanket accident or health insurance providing benefits
for medical or hospital expenses, shall provide to each individual
or group, or to the portion of each group comprised of certificate
holders of such insurance who are residents of this state, coverage
for the provision of nonprescription enteral formulas for the
treatment of impaired absorption of nutrients caused by disorders
affecting the absorptive surface, functional length, or motility
of the gastrointestinal tract. Such coverage shall be provided
when the prescribing physician has issued a written order stating
that the enteral formula is needed to sustain life, is medically
necessary, and is the least restrictive and most cost effective
means for meeting the needs of the patient.
II. Every nonprofit health service corporation
and every other similar corporation licensed under the laws of
another state that issues or renews any policy of individual
or group blanket accident or health insurance providing benefits
for medical or hospital expenses, shall provide to each individual
or group, or to the portion of each group comprised of certificate
holders of such insurance who are residents of this state, coverage
for the provision of nonprescription enteral formulas and food
products required for persons with inherited diseases of amino
acids and organic acids. Such coverage shall be provided when
the prescribing physician has issued a written order stating that
the enteral formula or food product is medically necessary and
is the least restrictive and most cost effective means for meeting
the needs of the patient. Coverage for inherited diseases of
amino acids [or] and organic acids shall, in addition
to the enteral formula, include food products modified to
be low protein in an amount not to exceed $1,800 annually for
any insured individual.
131:6 Individual Policies; Health Maintenance Organizations.
Amend RSA 420-B:8-ff, I and II to read as follows:
I. Every health maintenance organization and
every other similar corporation licensed under the laws of another
state that issues or renews any policy of individual or group
blanket health insurance providing benefits for medical or hospital
expenses, shall provide to each individual or group,
or to the portion of each group comprised of certificate holders
of such insurance who are residents of this state, coverage for
the provision of nonprescription enteral formulas for the treatment
of impaired absorption of nutrients caused by disorders affecting
the absorptive surface, functional length, or motility of the
gastrointestinal tract. Such coverage shall be provided when
the prescribing physician has issued a written order stating that
the enteral formula is needed to sustain life, is medically necessary,
and is the least restrictive and most cost effective means for
meeting the needs of the patient.
II. Every health maintenance organization and
every other similar corporation licensed under the laws of another
state that issues or renews any policy of individual or group
blanket health insurance providing benefits for medical or hospital
expenses, shall provide to each individual or group,
or to the portion of each group comprised of certificate holders
of such insurance who are resident of this state, coverage for
the provision of nonprescription enteral formulas and food products
required for persons with inherited diseases of amino acids and
organic acids. Such coverage shall be provided when the prescribing
physician has issued a written order stating that the enteral
formula or food product is medically necessary and is the least
restrictive and most cost effective means for meeting the needs
of the patient. Coverage for inherited diseases of amino acids
and organic acids shall, in addition to the enteral formula,
include food products modified to be low protein in an amount
not to exceed $1,800 annually for any insured individual.
131:7 Effective Date. This act shall take effect 60
days after its passage.
Approved: May 21, 1996
Effective: July 20, 1996