Assembly Bill No. 551–Assemblymen de Braga, Anderson,
Parks, Manendo and Carpenter

March 15, 1999

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Referred to Committee on Commerce and Labor

 

SUMMARY—Revises provisions regarding health insurance coverage for certain digestive disorders. (BDR 57-522)

FISCAL NOTE: Effect on Local Government: No.

Effect on the State or on Industrial Insurance: No.

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).

 

AN ACT relating to health insurance; revising certain provisions regarding mandatory 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:

1-1 Section 1. NRS 689A.0423 is hereby amended to read as follows:

1-2 689A.0423 1. A policy of health insurance must provide coverage

1-3 for:

1-4 (a) Enteral formulas for use at home that are prescribed or ordered by a

1-5 physician as medically necessary for the treatment of inherited metabolic

1-6 diseases characterized by deficient metabolism, or malabsorption

1-7 originating from congenital defects or defects arising shortly after birth, of

1-8 amino acid, organic acid, carbohydrate or fat; and

1-9 (b) At least [$2,500] $5,000 per year for special food products which

1-10 are prescribed or ordered by a physician as medically necessary for the

1-11 treatment of a person described in paragraph (a).

1-12 2. The coverage required by subsection 1 must be provided whether or

1-13 not the condition existed when the policy was purchased.

1-14 3. A policy subject to the provisions of this chapter that is delivered,

1-15 issued for delivery or renewed on or after January 1, 1998, has the legal

1-16 effect of including the coverage required by this section, and any provision

1-17 of the policy or the renewal which is in conflict with this section is void.

1-18 4. As used in this section:

2-1 (a) "Inherited metabolic disease" means a disease caused by an

2-2 inherited abnormality of the body chemistry of a person.

2-3 (b) "Special food product" means a food product that is specially

2-4 formulated to have less than one gram of protein per serving and is

2-5 intended to be consumed under the direction of a physician for the dietary

2-6 treatment of an inherited metabolic disease. The term does not include a

2-7 food that is naturally low in protein.

2-8 Sec. 2. NRS 689B.0353 is hereby amended to read as follows:

2-9 689B.0353 1. A policy of group health insurance must provide

2-10 coverage for:

2-11 (a) Enteral formulas for use at home that are prescribed or ordered by a

2-12 physician as medically necessary for the treatment of inherited metabolic

2-13 diseases characterized by deficient metabolism, or malabsorption

2-14 originating from congenital defects or defects arising shortly after birth, of

2-15 amino acid, organic acid, carbohydrate or fat; and

2-16 (b) At least [$2,500] $5,000 per year for special food products which

2-17 are prescribed or ordered by a physician as medically necessary for the

2-18 treatment of a person described in paragraph (a).

2-19 2. The coverage required by subsection 1 must be provided whether or

2-20 not the condition existed when the policy was purchased.

2-21 3. A policy subject to the provisions of this chapter that is delivered,

2-22 issued for delivery or renewed on or after January 1, 1998, has the legal

2-23 effect of including the coverage required by this section, and any provision

2-24 of the policy or the renewal which is in conflict with this section is void.

2-25 4. As used in this section:

2-26 (a) "Inherited metabolic disease" means a disease caused by an

2-27 inherited abnormality of the body chemistry of a person.

2-28 (b) "Special food product" means a food product that is specially

2-29 formulated to have less than one gram of protein per serving and is

2-30 intended to be consumed under the direction of a physician for the dietary

2-31 treatment of an inherited metabolic disease. The term does not include a

2-32 food that is naturally low in protein.

2-33 Sec. 3. NRS 695B.1923 is hereby amended to read as follows:

2-34 695B.1923 1. A contract for hospital or medical service must

2-35 provide coverage for:

2-36 (a) Enteral formulas for use at home that are prescribed or ordered by a

2-37 physician as medically necessary for the treatment of inherited metabolic

2-38 diseases characterized by deficient metabolism, or malabsorption

2-39 originating from congenital defects or defects arising shortly after birth, of

2-40 amino acid, organic acid, carbohydrate or fat; and

2-41 (b) At least [$2,500] $5,000 per year for special food products which

2-42 are prescribed or ordered by a physician as medically necessary for the

2-43 treatment of a person described in paragraph (a).

3-1 2. The coverage required by subsection 1 must be provided whether or

3-2 not the condition existed when the contract was purchased.

3-3 3. A contract subject to the provisions of this chapter that is delivered,

3-4 issued for delivery or renewed on or after January 1, 1998, has the legal

3-5 effect of including the coverage required by this section, and any provision

3-6 of the contract or the renewal which is in conflict with this section is void.

3-7 4. As used in this section:

3-8 (a) "Inherited metabolic disease" means a disease caused by an

3-9 inherited abnormality of the body chemistry of a person.

3-10 (b) "Special food product" means a food product that is specially

3-11 formulated to have less than one gram of protein per serving and is

3-12 intended to be consumed under the direction of a physician for the dietary

3-13 treatment of an inherited metabolic disease. The term does not include a

3-14 food that is naturally low in protein.

3-15 Sec. 4. NRS 695C.1723 is hereby amended to read as follows:

3-16 695C.1723 1. A health maintenance plan must provide coverage for:

3-17 (a) Enteral formulas for use at home that are prescribed or ordered by a

3-18 physician as medically necessary for the treatment of inherited metabolic

3-19 diseases characterized by deficient metabolism, or malabsorption

3-20 originating from congenital defects or defects arising shortly after birth, of

3-21 amino acid, organic acid, carbohydrate or fat; and

3-22 (b) At least [$2,500] $5,000 per year for special food products which

3-23 are prescribed or ordered by a physician as medically necessary for the

3-24 treatment of a person described in paragraph (a).

3-25 2. The coverage required by subsection 1 must be provided whether or

3-26 not the condition existed when the health maintenance plan was purchased.

3-27 3. Any evidence of coverage subject to the provisions of this chapter

3-28 that is delivered, issued for delivery or renewed on or after January 1,

3-29 1998, has the legal effect of including the coverage required by this

3-30 section, and any provision of the evidence of coverage or the renewal

3-31 which is in conflict with this section is void.

3-32 4. As used in this section:

3-33 (a) "Inherited metabolic disease" means a disease caused by an

3-34 inherited abnormality of the body chemistry of a person.

3-35 (b) "Special food product" means a food product that is specially

3-36 formulated to have less than one gram of protein per serving and is

3-37 intended to be consumed under the direction of a physician for the dietary

3-38 treatment of an inherited metabolic disease. The term does not include a

3-39 food that is naturally low in protein.

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