2006 Legislation
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HOUSE BILL NO. 644 – Insurance, cleft lip/cleft palate

HOUSE BILL NO. 644

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H0644...........................................................by BUSINESS
HEALTH INSURANCE - Amends existing law relating to insurance to require
coverage for medically necessary care for children born with cleft lip or
cleft palate.
                                                                        
02/10    House intro - 1st rdg - to printing
02/13    Rpt prt - to Bus

Bill Text


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-eighth Legislature                   Second Regular Session - 2006
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                                                                        
                                     HOUSE BILL NO. 644
                                                                        
                                   BY BUSINESS COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO INSURANCE; AMENDING SECTIONS 41-2140 AND 41-2210, IDAHO  CODE,  TO
  3        REQUIRE COVERAGE FOR MEDICALLY NECESSARY CARE FOR CHILDREN BORN WITH CLEFT
  4        LIP OR CLEFT PALATE; AMENDING SECTION 41-3437, IDAHO CODE, TO REQUIRE COV-
  5        ERAGE  FOR  MEDICALLY  NECESSARY  CARE FOR CHILDREN BORN WITH CLEFT LIP OR
  6        CLEFT PALATE AND TO MAKE  TECHNICAL  CORRECTIONS;  AND  AMENDING  SECTIONS
  7        41-3923  AND 41-4023, IDAHO CODE, TO REQUIRE COVERAGE FOR MEDICALLY NECES-
  8        SARY CARE FOR CHILDREN BORN WITH CLEFT LIP OR CLEFT PALATE.
                                                                        
  9    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 10        SECTION 1.  That Section 41-2140, Idaho Code, be, and the same  is  hereby
 11    amended to read as follows:
                                                                        
 12        41-2140.  REQUIRED  PROVISIONS.  (1)  Any  disability  insurance  contract
 13    delivered  or  issued  for  delivery in this state which provides coverage for
 14    injury or sickness for newborn dependent children of the insured,  shall  pro-
 15    vide  such coverage for such newborn children, including adopted newborn chil-
 16    dren that are placed with the adoptive insured within sixty (60) days  of  the
 17    adopted  child's  date  of birth, from and after the moment of birth. Coverage
 18    under the contract for an adopted  newborn  child  placed  with  the  adoptive
 19    insured  more  than sixty (60) days after the birth of the adopted child shall
 20    be from and after the date the child is so placed. Coverage provided in accord
 21    with this section shall include, but not be limited to, coverage for  congeni-
 22    tal  anomalies, including coverage consistent with subsection (5) of this sec-
 23    tion. For the purposes of this section, "child" means an  individual  who  has
 24    not  attained age eighteen (18) years as of the date of the adoption or place-
 25    ment for adoption. For the purposes of this section, "placed" shall mean phys-
 26    ical placement in the care of the adoptive insured, or in those  circumstances
 27    in  which such physical placement is prevented due to the medical needs of the
 28    child requiring placement in a medical facility, it shall mean when the  adop-
 29    tive insured signs an agreement for adoption of such child and signs an agree-
 30    ment  assuming  financial  responsibility  for  such  child.  Prior  to  legal
 31    finalization  of  adoption, the coverage required under the provisions of this
 32    subsection (1) as to a child placed for adoption with an insured continues  in
 33    the  same  manner  as  it  would with respect to a naturally born child of the
 34    insured until the first to occur of the following events:
 35        (a)  Date the child is removed permanently from  that  placement  and  the
 36        legal obligation terminates; or
 37        (b)  The  date the insured rescinds, in writing, the agreement of adoption
 38        or agreement assuming financial responsibility.
 39        (2)  An insurer shall not restrict coverage under a  disability  insurance
 40    policy  of  any  dependent  child  adopted by a participant or beneficiary, or
 41    placed with a participant or beneficiary for adoption, solely on the basis  of
 42    a  preexisting  condition  of  the child at the time the child would otherwise
 43    become eligible for coverage under the plan, if the adoption or placement  for
                                                                        
                                           2
                                                                        
  1    adoption  occurs which the participant or beneficiary is eligible for coverage
  2    under the plan.
  3        (3)  No policy of disability insurance which provides  maternity  benefits
  4    for  a  person  covered continuously from conception shall be issued, amended,
  5    delivered, or renewed in this state on or after January 1, 1977,  if  it  con-
  6    tains   any  exclusion,  reduction,  or  other  limitations  as  to  coverage,
  7    deductibles, or coinsurance provisions, as  to  involuntary  complications  of
  8    pregnancy,  unless  such provisions apply generally to all benefits paid under
  9    the policy. If a fixed amount is specified in such  policy  for  surgery,  the
 10    fixed  amounts  for surgical procedures involving involuntary complications of
 11    pregnancy shall be commensurate with other fixed amounts  payable  for  proce-
 12    dures  of  comparable difficulty and severity. In a case where a fixed  amount
 13    is payable for maternity  benefits,  involuntary  complications  of  pregnancy
 14    shall  be deemed an illness and entitled to benefits otherwise provided by the
 15    policy. Where the  policy  contains  a  maternity  deductible,  the  maternity
 16    deductible  shall  apply  only  to expenses resulting from normal delivery and
 17    cesarean section delivery; however, expenses for cesarean section delivery  in
 18    excess  of  the  deductible shall be treated as expenses for any other illness
 19    under the policy. This section shall apply to all disability  policies  except
 20    individual noncancelable or guaranteed renewable policies, issued or delivered
 21    before January 1, 1977.
 22        With respect to such individual noncancelable or guaranteed renewable pol-
 23    icies  issued  or delivered before January 1, 1977, the insurer shall communi-
 24    cate the availability of coverage of involuntary  complications  of  pregnancy
 25    when negotiating any changes in such policies.
 26        For purposes of this section, involuntary complications of pregnancy shall
 27    include,  but not be limited to, puerperal infection, eclampsia, cesarean sec-
 28    tion delivery, ectopic pregnancy, and toxemia.
 29        All policies subject to this section and issued,  amended,  delivered,  or
 30    renewed in this state on or after January 1, 1977, shall be construed to be in
 31    compliance with this section, and any provision in any such policy which is in
 32    conflict with this section shall be of no force or effect.
 33        (4)  From  and  after  January  1, 1998, no policy of disability insurance
 34    which provides medical expense maternity benefits, shall restrict benefits for
 35    any hospital length of stay in connection with childbirth for  the  mother  or
 36    newborn  child  in  a  manner that would be in conflict with the newborns' and
 37    mothers' health protection act of 1996.
 38        (5)  With regard to newborn children born with cleft lip or  cleft  palate
 39    or both, there shall be no age limit on benefits for such conditions, and care
 40    and  treatment  shall include to the extent medically necessary, but shall not
 41    be limited to, oral and facial surgery, surgical management and follow-up care
 42    by  plastic  surgeons  and  oral  surgeons,  prosthetic  treatment   such   as
 43    obturators,  speech  appliances  and  feeding  appliances, habilitative speech
 44    therapy, otolaryngology treatment, and audiological assessments and treatment.
                                                                        
 45        SECTION 2.  That Section 41-2210, Idaho Code, be, and the same  is  hereby
 46    amended to read as follows:
                                                                        
 47        41-2210.  REQUIRED  PROVISION IN GROUP AND BLANKET POLICIES. (1) Any group
 48    disability insurance contract or blanket disability insurance contract, deliv-
 49    ered or issued for delivery in this state which provides coverage  for  injury
 50    or  sickness for newborn dependent children of subscribers or other members of
 51    the covered group, shall provide coverage for such newborn children, including
 52    adopted newborn children that are placed with the adoptive subscriber or other
 53    member of the covered group within sixty (60) days of the adopted child's date
                                                                        
                                           3
                                                                        
  1    of birth, from and after the moment of birth. Coverage under the contract  for
  2    an  adopted  newborn child placed with the adoptive subscriber or other member
  3    of the covered group more than sixty (60) days after the birth of the  adopted
  4    child  shall  be from and after the date the child is so placed. Coverage pro-
  5    vided in accord with this section shall include, but not be limited to, cover-
  6    age for congenital anomalies, including coverage  consistent  with  subsection
  7    (5)  of this section. For the purposes of this section, "child" means an indi-
  8    vidual who has not attained  age eighteen (18) years as of  the  date  of  the
  9    adoption or placement for adoption. For the purposes of this section, "placed"
 10    shall  mean physical placement in the care of the adoptive subscriber or other
 11    member of the covered group, or in those circumstances in which such  physical
 12    placement  is prevented due to the medical needs of the child requiring place-
 13    ment in a medical facility, it shall mean  when  the  adoptive  subscriber  or
 14    other  member  of  the  covered  group signs an agreement for adoption of such
 15    child and signs an agreement assuming financial responsibility for such child.
 16    Prior to legal finalization of adoption, the coverage required under the  pro-
 17    visions  of  this subsection (1) as to a child placed for adoption with a sub-
 18    scriber or other member of the covered group continues in the same  manner  as
 19    it  would  with  respect  to a naturally born child of the subscriber or other
 20    member of the covered group until the first to occur of the following events:
 21        (a)  Date the child is removed permanently from  that  placement  and  the
 22        legal obligation terminates; or
 23        (b)  The  date  the  subscriber  or  other  member  of  the  covered group
 24        rescinds, in writing, the agreement  of  adoption  or  agreement  assuming
 25        financial responsibility.
 26        (2)  An  insurer  shall  not  restrict  coverage  under a group disability
 27    insurance contract or a blanket disability insurance contract of any dependent
 28    child adopted by a participant or beneficiary, or placed with a participant or
 29    beneficiary for adoption, solely on the basis of a preexisting condition of  a
 30    child at the time the child would otherwise become eligible for coverage under
 31    the  plan, if the adoption or placement for adoption occurs while the partici-
 32    pant or beneficiary is eligible for coverage under the plan.
 33        (3)  No policy of disability insurance which provides  maternity  benefits
 34    for  a  person  covered continuously from conception shall be issued, amended,
 35    delivered, or renewed in this state on or after January 1, 1977,  if  it  con-
 36    tains   any  exclusion,  reduction,  or  other  limitations  as  to  coverage,
 37    deductibles, or coinsurance provisions, as  to  involuntary  complications  of
 38    pregnancy,  unless  such provisions apply generally to all benefits paid under
 39    the policy. If a fixed amount is specified in such  policy  for  surgery,  the
 40    fixed  amounts  for surgical procedures involving involuntary complications of
 41    pregnancy shall be commensurate with other fixed amounts  payable  for  proce-
 42    dures of comparable difficulty and severity. In a case where a fixed amount is
 43    payable  for  maternity benefits, involuntary complications of pregnancy shall
 44    be deemed an illness and entitled to benefits otherwise provided by  the  pol-
 45    icy.  Where  the policy contains a maternity deductible, the maternity deduct-
 46    ible shall apply only to expenses resulting from normal delivery and  cesarean
 47    section delivery; however, expenses for cesarean section delivery in excess of
 48    the  deductible  shall  be treated as expenses for any other illness under the
 49    policy. This section shall apply to all disability policies except  any  group
 50    disability  policy  made subject to an applicable collective-bargaining agree-
 51    ment in effect before January 1, 1977.
 52        For purposes of this section, involuntary complications of pregnancy shall
 53    include, but not be limited to, puerperal infection, eclampsia, cesarean  sec-
 54    tion delivery, ectopic pregnancy, and toxemia.
 55        All  policies  subject  to this section and issued, amended, delivered, or
                                                                        
                                           4
                                                                        
  1    renewed in this state on or after January 1, 1977, shall be construed to be in
  2    compliance with this section, and any provision in any such policy which is in
  3    conflict with this section shall be of no force or effect.
  4        (4)  From and after January 1, 1998, no  policy  of  disability  insurance
  5    which provides medical expense maternity benefits, shall restrict benefits for
  6    any  hospital  length  of stay in connection with childbirth for the mother or
  7    newborn child in a manner that  would be in conflict with  the  newborns'  and
  8    mothers' health protection act of 1996.
  9        (5)  With  regard  to newborn children born with cleft lip or cleft palate
 10    or both, there shall be no age limit on benefits for such conditions, and care
 11    and treatment shall include to the extent medically necessary, but  shall  not
 12    be limited to, oral and facial surgery, surgical management and follow-up care
 13    by   plastic   surgeons  and  oral  surgeons,  prosthetic  treatment  such  as
 14    obturators, speech appliances  and  feeding  appliances,  habilitative  speech
 15    therapy, otolaryngology treatment, and audiological assessments and treatment.
                                                                        
 16        SECTION  3.  That  Section 41-3437, Idaho Code, be, and the same is hereby
 17    amended to read as follows:
                                                                        
 18        41-3437.  REQUIRED PROVISIONS -- INFANTS. (a1)  A  subscriber's  contract,
 19    delivered  or  issued  for  delivery in this state which provides coverage for
 20    injury or sickness for newborn dependent children of subscribers or other mem-
 21    bers of the covered group, shall provide coverage for such  newborn  children,
 22    including  adopted  newborn  children  that  are placed with the adoptive sub-
 23    scriber or other member of the covered group within sixty  (60)  days  of  the
 24    adopted  child's  date  of birth, from and after the moment of birth. Coverage
 25    under the contract for an adopted newborn child placed with the adoptive  sub-
 26    scriber  or  other member of the covered group more than sixty (60) days after
 27    the birth of the adopted child shall be from and after the date the  child  is
 28    so  placed.  Coverage  provided in accord with this section shall include, but
 29    not be limited to, coverage for congenital anomalies, including coverage  con-
 30    sistent with subsection (3) of this section. For the purposes of this section,
 31    "child" means an individual who has not attained age eighteen (18) years as of
 32    the  date  of the adoption or placement for adoption. For the purposes of this
 33    section, "placed" shall mean physical placement in the care  of  the  adoptive
 34    subscriber  or other member of the covered group, or in those circumstances in
 35    which such physical placement is prevented due to the  medical  needs  of  the
 36    child  requiring placement in a medical facility, it shall mean when the adop-
 37    tive subscriber or other member of the covered group signs  an  agreement  for
 38    adoption  of such child and signs an agreement assuming financial responsibil-
 39    ity for such child. Prior to legal  finalization  of  adoption,  the  coverage
 40    required  under  the  provisions  of this subsection  as to a child placed for
 41    adoption with a subscriber or other member of the covered group  continues  in
 42    the same manner as it would with respect to a naturally born child of the sub-
 43    scriber  or  other member of the covered group until the first to occur of the
 44    following events:
 45        (1a)  Date the child is removed permanently from that  placement  and  the
 46        legal obligation terminates; or
 47        (2b)  The  date  the  subscriber  or  other  member  of  the covered group
 48        rescinds, in writing, the agreement  of  adoption  or  agreement  assuming
 49        financial responsibility.
 50        (b2)  A   service   corporation   shall  not  restrict  coverage  under  a
 51    subscriber's contract of any dependent child adopted by a participant or bene-
 52    ficiary, or placed with a participant or beneficiary for adoption,  solely  on
 53    the  basis of a preexisting condition of the child at the time the child would
                                                                        
                                           5
                                                                        
  1    otherwise become eligible for coverage under the  plan,  if  the  adoption  or
  2    placement for adoption occurs while the participant or beneficiary is eligible
  3    for coverage under the plan.
  4        (3)  With  regard  to newborn children born with cleft lip or cleft palate
  5    or both, there shall be no age limit on benefits for such conditions, and care
  6    and treatment shall include to the extent medically necessary, but  shall  not
  7    be  limited  to,  oral  and facial surgery,  surgical management and follow-up
  8    care by plastic surgeons and  oral  surgeons,  prosthetic  treatment  such  as
  9    obturators,  speech  appliances  and  feeding  appliances, habilitative speech
 10    therapy, otolaryngology treatment, and audiological assessments and treatment.
                                                                        
 11        SECTION 4.  That Section 41-3923, Idaho Code, be, and the same  is  hereby
 12    amended to read as follows:
                                                                        
 13        41-3923.  COVERAGE  OF  ADOPTED  NEWBORN CHILDREN -- COVERAGE OF MATERNITY
 14    AND COMPLICATIONS OF PREGNANCY. (1)  Any  contract  delivered  or  issued  for
 15    delivery  in  this  state  by an organization offering a managed care plan for
 16    which a certificate of authority is  required,  which  provides  coverage  for
 17    injury  or  sickness for newborn dependent children of the members of the cov-
 18    ered group, shall provide such coverage for such newborn children and infants,
 19    including adopted newborn children that are placed with the adoptive member of
 20    the covered group within sixty (60) days of the adopted child's date of birth,
 21    from and after the moment of birth. Coverage under the contract for an adopted
 22    newborn child placed with the adoptive member of the covered group  more  than
 23    sixty  (60)  days after the birth of the adopted child shall be from and after
 24    the date the child is so placed. Coverage provided in accord with this section
 25    shall include, but not be  limited  to,  coverage  for  congenital  anomalies,
 26    including  coverage  consistent  with  subsection (5) of this section. For the
 27    purposes of this section, "child" means an  individual  who  has  not  reached
 28    eighteen  (18) years as of the date of the adoption or placement for adoption.
 29    For the purposes of this section, "placed" shall mean  physical  placement  in
 30    the  care  of  the  adoptive  member of the covered group, or in those circum-
 31    stances in which such physical placement is prevented due to the medical needs
 32    of the child requiring placement in a medical facility, it shall mean when the
 33    adoptive member of the covered group signs an agreement for adoption  of  such
 34    child and signs an agreement assuming financial responsibility for such child.
 35    Prior  to legal finalization of adoption, the coverage required under the pro-
 36    visions of this subsection (1) as to a child placed for adoption with a member
 37    of the covered group continues in the same manner as it would with respect  to
 38    a   naturally born child of the member of the covered group until the first to
 39    occur of the following events:
 40        (a)  Date the child is removed permanently from  that  placement  and  the
 41        legal obligation terminates; or
 42        (b)  The  date  the  member of the covered group rescinds, in writing, the
 43        agreement of adoption or agreement assuming financial responsibility.
 44        (2)  The managed care organization shall not  restrict  coverage  under  a
 45    health  care  contract  of  any dependent child adopted by a member, or placed
 46    with a member for adoption, solely on the basis of a preexisting condition  of
 47    the  child  at the time the child would otherwise become eligible for coverage
 48    under the plan, if the adoption or placement for  adoption  occurs  while  the
 49    member is  eligible for coverage under the plan.
 50        (3)  No  health care contract which provides maternity benefits for a per-
 51    son covered continuously from conception shall be issued, amended,  delivered,
 52    or  renewed  in  this  state if it contains any exclusion, reduction, or other
 53    limitations as to coverage, deductibles, copayments, or coinsurance provisions
                                                                        
                                           6
                                                                        
  1    as to involuntary complications of pregnancy,  unless  such  provisions  apply
  2    generally  to all benefits paid under the plan. If a fixed amount is specified
  3    in such plan for surgery, the fixed amounts for surgical procedures  involving
  4    involuntary  complications of pregnancy shall be commensurate with other fixed
  5    amounts payable for procedures  of comparable difficulty and  severity.  In  a
  6    case  where  a  fixed  amount  is  payable for maternity benefits, involuntary
  7    complications of pregnancy shall be deemed an illness and entitled to benefits
  8    otherwise provided by the plan. Where the plan contains  a  maternity  deduct-
  9    ible,  the  maternity  deductible  shall apply only to expenses resulting from
 10    normal delivery and cesarean section delivery; however, expenses for  cesarean
 11    section  delivery in excess of the deductible shall be treated as expenses for
 12    any other illness under the plan.
 13        Where a plan which provides or arranges direct health  care  services  for
 14    its  members  contains  a maternity deductible, the maternity deductible shall
 15    apply only to expenses resulting from prenatal  care  and  delivery.  However,
 16    expenses  resulting from any delivery in excess of the deductible amount shall
 17    be treated as expenses for any other illness under the plan. If the  pregnancy
 18    is  interrupted, the maternity deductible charged for prenatal care and deliv-
 19    ery shall be based on the value of the medical  services  received,  providing
 20    that  it  is  never more than two-thirds (2/3) of the plan's maternity deduct-
 21    ible.
 22        This section shall apply to all health care  contracts  except  any  group
 23    health  care  contracts  made  subject  to an applicable collective-bargaining
 24    agreement in effect before January 1, 1977.
 25        For purposes of this section, involuntary complications of pregnancy shall
 26    include, but not be limited to, puerperal infection, eclampsia, cesarean  sec-
 27    tion delivery, ectopic pregnancy, and toxemia.
 28        All  health  care  contracts  subject to this section and issued, amended,
 29    delivered, or renewed in this state on or after January 1, 1977, shall be con-
 30    strued to be in compliance with this section, and any provision  in  any  such
 31    plan which is in conflict with this section shall be of no force or effect.
 32        (4)  From  and  after  January  1, 1998, no policy of disability insurance
 33    which provides medical expense maternity benefits shall restrict benefits  for
 34    any  hospital  length  of stay in connection with childbirth for the mother or
 35    newborn child in a manner that would be in conflict  with  the  newborns'  and
 36    mothers' health protection act of 1996.
 37        (5)  With  regard  to newborn children born with cleft lip or cleft palate
 38    or both, there shall be no age limit on benefits for such conditions, and care
 39    and treatment shall include to the extent medically necessary, but  shall  not
 40    be limited to, oral and facial surgery, surgical management and follow-up care
 41    by   plastic   surgeons  and  oral  surgeons,  prosthetic  treatment  such  as
 42    obturators, speech appliances  and  feeding  appliances,  habilitative  speech
 43    therapy, otolaryngology treatment, and audiological assessments and treatment.
                                                                        
 44        SECTION  5.  That  Section 41-4023, Idaho Code, be, and the same is hereby
 45    amended to read as follows:
                                                                        
 46        41-4023.  COVERAGE FROM MOMENT OF BIRTH -- COMPLICATIONS OF PREGNANCY. (1)
 47    Every self-funded plan issued in this state or providing coverage to any  cov-
 48    ered  family  residing  within  this state, shall contain a provision granting
 49    immediate accident and sickness coverage, from and after the moment of  birth,
 50    to  each  newborn  child  or infant of any covered family covered, including a
 51    newborn child placed with the adoptive covered family within sixty  (60)  days
 52    of  the adopted child's date of birth. Coverage under the self-funded plan for
 53    an adopted newborn child placed with the adoptive  covered  family  more  than
                                                                        
                                           7
                                                                        
  1    sixty  (60)  days after the birth of the adopted child shall be from and after
  2    the date the child is so placed. Coverage provided in accord with this section
  3    shall include, but not be limited to,  coverage  for  congenital    anomalies,
  4    including  coverage  consistent  with  subsection (4) of this section. For the
  5    purposes of this section, "child" means  an individual  who  has  not  reached
  6    eighteen  (18) years as of the date of the adoption or placement for adoption.
  7    For the purposes of this section, "placed" shall mean  physical  placement  in
  8    the  care  of  the adoptive covered family, or in those circumstances in which
  9    such physical placement is prevented due to the medical  needs  of  the  child
 10    requiring  placement  in  a  medical facility, it shall mean when the adoptive
 11    covered family signs an agreement for adoption of  such  child  and  signs  an
 12    agreement  assuming  financial  responsibility  for such child. Prior to legal
 13    finalization of adoption, the coverage required under the provisions  of  this
 14    subsection (1) as to a child placed for adoption with a covered family contin-
 15    ues  in  the same manner as it would with respect to a naturally born child of
 16    the covered family until the first to occur of the following events:
 17        (a)  Date the child is removed permanently from  that  placement  and  the
 18        legal obligation terminates; or
 19        (b)  The  date  the  covered family rescinds, in writing, the agreement of
 20        adoption or agreement assuming financial responsibility. No such plan  may
 21        be issued or amended if it contains any disclaimer, waiver, or other limi-
 22        tation  of coverage relative to the coverage or insurability of newborn or
 23        adopted children or infants of a covered family covered from and after the
 24        moment of birth that is inconsistent with the provisions of this section.
 25        (2)  An insurer shall not restrict coverage under a  self-funded  plan  of
 26    any  dependent child adopted by a participant or beneficiary, or placed with a
 27    participant or beneficiary for adoption, solely on the basis of a  preexisting
 28    condition  of  the child at the time the child would otherwise become eligible
 29    for coverage under the plan, if the adoption or placement for adoption  occurs
 30    while the participant or beneficiary is eligible for coverage under the plan.
 31        (3)  No  self-funded  plan  which provides maternity benefits for a person
 32    covered continuously from conception shall be issued, amended,  delivered,  or
 33    renewed  in  this state on or after January 1, 1977, if it contains any exclu-
 34    sion, reduction, or other limitations as to coverage, deductibles, or coinsur-
 35    ance provisions as to involuntary complications of pregnancy, unless such pro-
 36    visions apply generally to all benefits paid under the plan. If a fixed amount
 37    is specified in such plan for surgery, the fixed amounts for  surgical  proce-
 38    dures  involving  involuntary complications of pregnancy shall be commensurate
 39    with other fixed amounts payable for procedures of comparable  difficulty  and
 40    severity.  In  a  case where a fixed amount is payable for maternity benefits,
 41    involuntary complications of pregnancy shall be deemed an illness and entitled
 42    to benefits otherwise provided by the plan. Where the plan contains  a  mater-
 43    nity deductible, the maternity deductible shall apply only to expenses result-
 44    ing  from normal delivery and cesarean section delivery; however, expenses for
 45    cesarean section delivery in excess of the  deductible  shall  be  treated  as
 46    expenses for any other illness under the plan. This subdivision shall apply to
 47    all  self-funded  plans  except  any  such  plan made subject to an applicable
 48    collective-bargaining agreement in effect before January 1, 1977.
 49        For purposes of this subdivision, involuntary complications  of  pregnancy
 50    shall include, but not be limited to, puerperal infection, eclampsia, cesarean
 51    section delivery, ectopic pregnancy, and toxemia.
 52        All  plans  subject to this subdivision and issued, amended, delivered, or
 53    renewed in this state on or after January 1, 1977, shall be construed to be in
 54    compliance with this section, and any provision in any such plan which  is  in
 55    conflict with this section shall be of no force or effect.
                                                                        
                                           8
                                                                        
  1        (4)  With  regard  to newborn children born with cleft lip or cleft palate
  2    or both, there shall be no age limit on benefits for such conditions, and care
  3    and treatment shall include to the extent medically necessary, but  shall  not
  4    be limited to, oral and facial surgery, surgical management and follow-up care
  5    by   plastic   surgeons  and  oral  surgeons,  prosthetic  treatment  such  as
  6    obturators, speech appliances  and  feeding  appliances,  habilitative  speech
  7    therapy, otolaryngology treatment, and audiological assessments and treatment.

Statement of Purpose / Fiscal Impact



                       STATEMENT OF PURPOSE

                             RS 15692

This legislation proposes amending multiple sections of the Idaho
Code to require coverage for medically necessary care for
children born with cleft lip or cleft palate.



                           FISCAL NOTE

This legislation will result in an estimated savings of over
$100,000 to the Children's Special Health Program funded through
the Division of Health.




Contact
Name: Rep. Margaret Henbest 
Phone: 332-1000


STATEMENT OF PURPOSE/FISCAL NOTE                         H 644