Applies to individual policies from insurers, group or blanket policies from insurers, group or blanket policies from health service corporations, and group or blanket policies from health maintenance organizations. Insurers are required to cover insulin, oral medications to treat diabetes and equipment, but only if they offer a prescription drug rider. Coverage for Amputees: n : Coverage for certain prosthetic devices. Coverage for amputees: C. Coverage for people with diabetes may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same contract, as long as the annual deductibles or coinsurance for benefits are no greater than the annual deductibles or coinsurance established for similar benefits within a given contract.
The law also requires coverage for medically necessary diabetes self-management education and education relating to diet, including home visits, when provided by:. May be subject to the same annual deductibles or coinsurance as may be deemed appropriate and as are consistent with those established for other covered policy benefits. Coverage for Amputees: HB : Requires coverage under health insurance policy for prosthetic and orthotic devices.
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Subject to the annual deductibles or coinsurance requirements imposed for similar coverage under the same health policy. Coverage for Amputees: : Coverage for prostheses and treatment of physical complications. The benefits provided in this section are subject to the same dollar limits, deductibles, coinsurance and other restrictions established for all other benefits covered in the policy. Any individual, franchise, blanket or group health insurance policy; medical service plan; contract; hospital service corporation contract; hospital and medical service corporation contract; fraternal benefit society; health maintenance organization; preferred provider organization or managed care organization that provides hospital, surgical or medical expense insurance.
All supplies, including medications and equipment for the control of diabetes shall be dispensed as written, including brand-name products, unless substitution is approved by the physician or practitioner who issues the written order for the supplies or equipment. A health benefit plan can require a deductible, copayment or coinsurance for coverage provided under this section. Durational limits, amount limits, deductibles and coinsurance for treatment of diabetes are to be equitable or identical to coverage provided for treatment of other illnesses or diseases.
The term does not apply to limited coverage for specified disease or other limited benefit coverage. Benefits required to be covered by this section shall be subject to the same dollar limits, deductibles and coinsurance factors within the provisions of the health insurance policy. No insurer, corporation or health maintenance organization shall impose upon any person receiving benefits pursuant to this section any copayment, fee or condition that is not equally imposed upon all individuals in the same benefit category, nor shall any insurer, corporation or health maintenance organization impose any policy-year or calendar-year dollar or durational benefit limitations or maximums for benefits or services provided under this section.
Coverage required under this section may be subject to customary cost-sharing provisions established for all other similar services or supplies within a policy. Coverage for diabetes equipment and supplies is required only when the contract or insurance policy provides for prescription coverage. Any deductible or coinsurance billed for any service as provided in this section shall apply equally with all other coverages provided by the insurer but not included in this section. WI ST Coverage required under this paragraph shall be subject to the same exclusions, limitations, deductibles and coinsurance provisions of the plan as other covered expenses, except that insulin infusion pump coverage may be limited to purchase of one pump per year, and the plan may require the covered person to use a pump for 30 days before purchase.
Department of Health. Visit the website. Katie Mason authored the updates. Andrew Thangasamy provided additional research and editing for the edition. It will be updated regularly to reflect new laws and state statistics. Nutritional diagnostic, therapeutic, and counseling services provided by a registered dietitian. A contract between a corporation and its subscribers to provide certain medical services. Insulin-dependent diabetes Insulin-using diabetes Gestational diabetes Non-insulin-using diabetes. Coverage for the cost of diabetes outpatient self-management training or education and for the cost of medical nutrition therapy is required only if provided by a health care provider trained in diabetes treatment of diabetes.
Alaska requires coverage for medical nutritional therapy, equipment and supplies only when the contract or insurance policy has prescription drug coverage. Blood glucose monitors. Blood glucose monitors for the legally blind. Test strips for glucose monitors and visual reading and urine testing strips.
Insulin preparations and glucagon. Insulin cartridges. Drawing up devices and monitors for the visually impaired.
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Injection aids. Insulin cartridges for the legally blind. Syringes and lancets including automatic lancing devices. Prescribed oral agents for controlling blood sugar that are included on the plan formulary. To the extent coverage is required under Medicare, podiatry appliances for prevention of complications associated with diabetes. Any other device, medication, equipment or supply for which coverage is required under Medicare from and after Jan 1, The coverage required in this paragraph is effective six months after the coverage is required under Medicare. Date effective: Aug 1, Blood glucose monitors, which include all commercially available blood glucose monitors designed for patient use and for those who have been diagnosed with diabetes.
Blood glucose monitors for the legally blind, which include all commercially available blood glucose monitors designed for patient use with adaptive devices and for those who are legally blind and have been diagnosed with diabetes. Test strips for glucose monitors, which include all test strips approved by the Federal Food and Drug Administration, glucose control solutions, lancet devices, and lancets for monitoring glycemic control. Visual reading and urine testing strips, which include visual reading strips for glucose, urine testing strips for ketones, or urine test strips for both glucose and ketones.
Urine test strips for glucose only are not acceptable as the sole method of monitoring. Insulin, which includes all commercially available insulin preparations including insulin analog preparations available in either vial or cartridge. Injection aids, which include devices used to assist with insulin injection. Syringes, which include insulin syringes, pen-like insulin injection devices and pen needles for pen-like insulin injection devices.
Insulin pumps as prescribed by the physician and appurtenances thereto, which include insulin infusion pumps and supplies such as skin preparations, adhesive supplies, infusion sets, cartridges, batteries and other disposable supplies needed to maintain insulin pump therapy. These include durable and disposable devices used to assist in the injection of insulin. Oral agents for controlling the blood sugar level, which are prescription drugs. Podiatric appliances to prevent of complications associated with diabetes, which include therapeutic molded or depth-inlay shoes, replacement inserts, preventive devices, and shoe modifications for prevention and treatment.
Glucagon emergency kits and injectable glucagon. Insulin-using diabetes Non-insulin-using diabetes Gestational diabetes.
Prescriptive medications to treat diabetes. Blood glucose monitors and blood glucose testing strips. Blood glucose monitors designed to assist the visually impaired. Insulin pumps and all related necessary supplies. Ketone urine testing strips. Lancets and lancet puncture devices. Pen delivery systems to administer insulin. Podiatric devices to prevent or treat diabetes-related complications. Insulin syringes. Visual aids, excluding eyewear, to help the visually impaired with proper dosing of insulin.
Diabetes outpatient self-management training. Benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to avoid frequent hospitalization and complications. Any health benefit plan, except supplemental policies that cover a specified disease or other limited benefit, that provides hospital, surgical or medical expense insurance shall provide coverage for diabetes.
See below under "Special features and issues" for more detailed information. Each individual health insurance policy that provides coverage delivered, issued for delivery or renewed in this state on or after Oct 1, , shall provide coverage for laboratory and diagnostic tests for all types of diabetes. Date enacted: June Every individual or group hospital service corporation contract, individual or group medical service corporation contract, individual or group health service corporation contract, individual health insurance policy, group health insurance policy, and contract for health care services that provides hospital, outpatient services, or medical expense benefits and provides coverage for prescription drugs and that is delivered, issued, executed, or renewed in this State pursuant to Title 18 of the Delaware Code or is approved for issuance or renewal in this State by the Insurance Commissioner shall provide benefits to any subscriber or other person covered there under for expenses incurred for the following equipment and supplies for the treatment of diabetes see below , if recommended in writing or prescribed by a physician.
Pharmacological agents for controlling blood sugar. Insulin pumps. Blood glucose meters and strips. Urine testing strips. Program administrator: Pfizer Health Solutions. State has a mail order pharmacy benefit under its diabetes demonstration waiver. Effective date: July 1, Every individual major medical and group health insurance policy, group health insurance plan or policy, and any other form of managed or capitated care plans or policies is subject to statute. A group policy of accident and health insurance that is amended, delivered, issued or renewed after the effective date of this amendatory act of shall provide coverage.
Type 1 diabetes Type 2 diabetes Gestational diabetes mellitus. Lancets and lancing devices. Pen needles. Test strips.
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Glucagon kits. A prepaid hospital or medical service plan. A health maintenance organization. A state employee health benefit plan. The state Medicaid plan. Any person providing a plan of health insurance subject to state insurance law. Any individual, covered by a health insurance plan issued by an insurer, who has: Insulin-using diabetes; Non-insulin using diabetes; or Elevated blood glucose levels induced by pregnancy or another medical condition. Policies or contracts providing for third-party payment or prepayment of health or medical expenses.
This section applies to the following classes of third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state on or after July 1, Program administrator: Iowa Medicaid Enterprise. Any individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization that provides coverage for accident and health services and that is delivered, issued for delivery, amended or renewed on or after Jan 1, Insulin dependent diabetes Insulin-using diabetes Gestational diabetes Non-insulin-using diabetes.
Notes: The provisions of this act shall not apply to any Medicare supplement policy of insurance, as defined by the commissioner of insurance by rule and regulation or any policy of long-term care insurance. All health benefit plans issued or renewed on or after July 15, , shall provide coverage.
Insurers in the individual, small group or employer-organized association markets that offer a basic health benefit plan. Any hospital, health, or medical expense insurance policy, hospital or medical service contract, health and accident insurance policy, or any other contract of this type providing comprehensive major medical benefits, including a group insurance plan, or any policy of family group, blanket, or association health and accident insurance, a self-insurance plan, an employee welfare benefit plan, or a health maintenance organization subscriber agreement that is issued or renewed in this state on or after Jan 1, , or the Office of Group Benefits programs shall provide coverage.
Insulin-dependent diabetes Insulin-using diabetes Gestational diabetes Non-insulin using diabetes. One-time evaluation and training program per policy for diabetes self-management when medically necessary as determined by a physician. ME ST T. All individual and group nonprofit hospital and medical services plan policies, contracts and certificates and all nonprofit health care plan policies, contracts and certificates; all individual health policies and contracts, except accidental injury, specified disease, hospital indemnity, Medicare supplement, long-term care and other limited benefit health insurance policies and contracts, must provide coverage for the medically appropriate and necessary equipment used to treat diabetes.
Oral hypoglycemic agents. Test strips, lancets and syringes. Insulin-using diabetes Non-insulin-dependent diabetes Elevated blood glucose levels induced by pregnancy. Contributory group general or blanket insurance for those in the service of the Commonwealth. An individual policy of accident and sickness insurance issued pursuant to section that provides hospital expense and surgical expense insurance. Any group blanket policy of accident and sickness insurance issued pursuant to section that provides hospital expense and surgical expense insurance.
A contract between a subscriber and the corporation under an individual or group hospital service plan that provides hospital expense and surgical expense insurance. A subscription certificate under an individual or group medical service agreement that provides hospital expense and surgical expense insurance. Any individual or group health maintenance contract.
Insulin-dependent diabetes Insulin-using diabetes Gestational diabetes Non-insulin-dependent diabetes. Prescribed oral diabetes medications that influence blood sugar levels. Blood glucose monitoring strips for home use. Voice-synthesizers for blood glucose monitors for use by the legally blind. Visual magnifying aids for use by the legally blind.
Urine glucose strips; ketone strips. Laboratory tests, including glycosylated hemoglobin, or HbAlc, tests. Insulin pumps and insulin pump supplies. Insulin pens. Medical nutritional therapy included, when provided by a certified diabetes health care provider participating with the health maintenance contract or affiliated with a provider participating with the health maintenance contract. Outpatient self-management training, when provided by a certified diabetes health care provider participating with the health maintenance contract or affiliated with a provider participating with the health maintenance contract.
MI ST A health care corporation certificate shall provide benefits in each group and nongroup certificate for medically necessary medications prescribed by an allopathic, osteopathic or podiatric physician and used to treat foot ailments, infections and other medical conditions of the foot, ankle or nails associated with diabetes. An insurer providing an expense-incurred hospital, medical or surgical policy or certificate delivered or issued for delivery in this state and a health maintenance organization shall establish and provide to insureds, enrollees and participating providers a program to prevent the onset of clinical diabetes.
This program for participating providers shall emphasize best practice guidelines to prevent the onset of clinical diabetes and to treat diabetes, including, but not limited to, diet, lifestyle, physical exercise and fitness, and early diagnosis and treatment. Gestational diabetes Insulin-dependent diabetes Non-insulin-dependent diabetes. Insulin, if prescribed by an allopathic or osteopathic physician. Nonexperimental medication for controlling blood sugar, if prescribed by an allopathic or osteopathic physician. Medications used to treat of foot ailments, infections and other medical conditions of the foot, ankle or nails associated with diabetes, if prescribed by an allopathic, osteopathic or podiatric physician.
Blood glucose monitors and blood glucose monitors for the legally blind. Test strips for glucose monitors. Visual reading and urine testing strips. Lancets and spring-powered lancet devices. Insulin pumps and medical supplies required for the use of an insulin pump. A health plan, including a plan providing the coverage specified in section 62A.
All physician-prescribed medically appropriate and necessary equipment and supplies used to manage and treat diabetes. This exception does not apply to a health plan providing the coverage specified in section 62A. The basic Medicare supplement plan must have a level of coverage that will provide 80 percent of coverage for all physician-prescribed medically appropriate and necessary equipment and supplies used in the management and treatment of diabetes not otherwise covered under Part D of the Medicare program.
Code Ann. Missouri is one of three states that require health insurers to offer at least one type of policy that includes coverage of diabetes treatment, but does not require such coverage as a mandated benefit. The law states: "Each entity that offers individual and group health insurance policies that provide coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a health services corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group arrangements, to the extent not preempted by federal law, and all managed health care delivery entities of any type or description, that are delivered, issued for delivery, continued or renewed in this state on or after Jan 1, , shall offer coverage.
Coverage for all physician-prescribed medically appropriate and necessary equipment, supplies and self-management training used to manage and treat diabetes. No greater than any other health care service provided by the policy. Program administrator: State of Missouri. Any group disability policy, certificate of insurance, or membership contract is required to provide coverage. One prescriptive oral agent for controlling blood sugar levels for each class of drug. Devices to self-monitor glucose levels including those for the visually impaired.
Visual reading and urine test strips. One insulin pump for each warranty period. Accessories to insulin pumps. Glucagon emergency kits. Any individual or group sickness and accident insurance policy or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited-benefit coverage, and any self-funded employee benefit plan to the extent not preempted by federal law shall include coverage.
Lancet and lancet devices. Insulin pumps and all supplies for the pump. Insulin infusion devices. Oral agents for controlling blood sugars. Glucose agents and glucagon kits. Insulin measurement. Administration aids for the visually impaired. Patient management materials that provide essential diabetes self-management information. Podiatric appliances to prevent complications associated with diabetes. NV ST A. Policy of health insurance, group policy of insurance, and contract for hospital or medical service that provides coverage for hospital, medical or surgical expenses, and health maintenance organizations.
Training and education that is medically necessary as a result of a subsequent diagnosis that indicates a significant change in the symptoms or condition of the insured person and that requires modification of the program of self-management of diabetes. Training and education that is medically necessary due to the development of new techniques and treatment for diabetes.
Medically appropriate or necessary insulin. Oral agents. Hospital service corporation contracts, medical service corporation contracts, health service corporation contracts, individual health insurance policies, group health insurance policies, and health care services contracts. Oral agents for controlling blood sugar. Test strips for glucose monitors and visual reading and urine testing strips Injection aids.
Cartridges for the legally blind. Insulin pumps and appurtenances thereto.
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Benefits shall be provided to the same extent as for any other sickness under the policy. Insulin-using diabetes Non-insulin-using diabetes Elevated blood glucose levels induced by pregnancy. Blood glucose monitors, including those for the legally blind. Test strips for blood glucose monitors.
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Visual reading urine and ketone strips. Lancets and lancet devices. Injection aids, including those adaptable to meet the needs of the legally blind. Prescriptive oral agents for controlling blood sugar levels. Whether it's helping you resolve payment and reimbursement problems, developing practice management tools for you and your staff, creating programs to improve public health or finding the best deals on services that are relevant to you, MSMA is fighting for the physicians who care for Mississippi every single day.
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