View Bill Status
View Bill Text
View Statement of Purpose / Fiscal Impact
H0667.................................................by HEALTH AND WELFARE
HEALTH INSURANCE - Amends existing law relating to insurance to require
certain disability insurance contracts, group disability insurance
contracts, blanket disability insurance contracts, subscriber contracts,
managed care organization plans and self-funded plans to provide coverage
for special medical formulas and early intervention services up to a
specified benefit limit.
02/13 House intro - 1st rdg - to printing
02/14 Rpt prt - to Health/Wel
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature Second Regular Session - 2006
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 667
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO INSURANCE; AMENDING SECTION 41-2140, IDAHO CODE, TO REQUIRE CER-
3 TAIN DISABILITY INSURANCE CONTRACTS TO PROVIDE COVERAGE FOR SPECIAL MEDI-
4 CAL FORMULAS AND EARLY INTERVENTION SERVICES UP TO A SPECIFIED BENEFIT
5 LIMIT AND TO MAKE A TECHNICAL CORRECTION; AMENDING SECTION 41-2210, IDAHO
6 CODE, TO REQUIRE CERTAIN GROUP DISABILITY INSURANCE CONTRACTS AND BLANKET
7 DISABILITY INSURANCE CONTRACTS TO PROVIDE COVERAGE FOR SPECIAL MEDICAL
8 FORMULAS AND EARLY INTERVENTION SERVICES UP TO A SPECIFIED BENEFIT LIMIT;
9 AMENDING SECTION 41-3437, IDAHO CODE, TO REQUIRE CERTAIN SUBSCRIBER CON-
10 TRACTS TO PROVIDE COVERAGE FOR SPECIAL MEDICAL FORMULAS AND EARLY INTER-
11 VENTION SERVICES UP TO A SPECIFIED BENEFIT LIMIT; AMENDING SECTION
12 41-3923, IDAHO CODE, TO REQUIRE MANAGED CARE ORGANIZATION PLANS TO PROVIDE
13 CERTAIN COVERAGE FOR SPECIAL MEDICAL FORMULAS AND EARLY INTERVENTION SER-
14 VICES UP TO A SPECIFIED BENEFIT LIMIT AND TO MAKE A TECHNICAL CORRECTION;
15 AND AMENDING SECTION 41-4023, IDAHO CODE, TO REQUIRE CERTAIN SELF-FUNDED
16 PLANS TO PROVIDE CERTAIN COVERAGE FOR SPECIAL MEDICAL FORMULAS AND EARLY
17 INTERVENTION SERVICES UP TO A SPECIFIED BENEFIT LIMIT AND TO MAKE TECHNI-
18 CAL CORRECTIONS.
19 Be It Enacted by the Legislature of the State of Idaho:
20 SECTION 1. That Section 41-2140, Idaho Code, be, and the same is hereby
21 amended to read as follows:
22 41-2140. REQUIRED PROVISIONS. (1) Any disability insurance contract
23 delivered or issued for delivery in this state which provides coverage for
24 injury or sickness for newborn dependent children of the insured, shall pro-
25 vide such coverage for such newborn children, including adopted newborn chil-
26 dren that are placed with the adoptive insured within sixty (60) days of the
27 adopted child's date of birth, from and after the moment of birth. Coverage
28 under the contract for an adopted newborn child placed with the adoptive
29 insured more than sixty (60) days after the birth of the adopted child shall
30 be from and after the date the child is so placed. Coverage provided in accord
31 with this section shall include, but not be limited to, coverage for congeni-
32 tal anomalies, and shall also include those special medical formulas which are
33 approved by the director of the department of health and welfare, prescribed
34 by a physician, and are medically necessary for treatment of phenylketonuria,
35 tyrosinemia, homocystinuria, maple syrup urine disease, propionic acidemia, or
36 methylmalonic acidemia in infants and children or medically necessary to pro-
37 tect the unborn fetuses of pregnant women with phenylketonuria. The dependent
38 coverage of any such contract shall also provide coverage for medically neces-
39 sary intervention services delivered by certified early intervention special-
40 ists, as defined by the department of health and welfare in rule and in accor-
41 dance with applicable certification requirements; provided however, the reim-
42 bursement of costs for such services shall have a maximum benefit of three
43 thousand five hundred dollars ($3,500) per year per child, after which the
2
1 department of health and welfare shall pay for such early intervention ser-
2 vices if the child otherwise qualifies. For the purposes of this section,
3 "child" means an individual who has not attained age eighteen (18) years as of
4 the date of the adoption or placement for adoption. For the purposes of this
5 section, "placed" shall mean physical placement in the care of the adoptive
6 insured, or in those circumstances in which such physical placement is pre-
7 vented due to the medical needs of the child requiring placement in a medical
8 facility, it shall mean when the adoptive insured signs an agreement for
9 adoption of such child and signs an agreement assuming financial responsibil-
10 ity for such child. Prior to legal finalization of adoption, the coverage
11 required under the provisions of this subsection (1) as to a child placed for
12 adoption with an insured continues in the same manner as it would with respect
13 to a naturally born child of the insured until the first to occur of the fol-
14 lowing events:
15 (a) Date the child is removed permanently from that placement and the
16 legal obligation terminates; or
17 (b) The date the insured rescinds, in writing, the agreement of adoption
18 or agreement assuming financial responsibility.
19 (2) An insurer shall not restrict coverage under a disability insurance
20 policy of any dependent child adopted by a participant or beneficiary, or
21 placed with a participant or beneficiary for adoption, solely on the basis of
22 a preexisting condition of the child at the time the child would otherwise
23 become eligible for coverage under the plan, if the adoption or placement for
24 adoption occurs which while the participant or beneficiary is eligible for
25 coverage under the plan.
26 (3) No policy of disability insurance which provides maternity benefits
27 for a person covered continuously from conception shall be issued, amended,
28 delivered, or renewed in this state on or after January 1, 1977, if it con-
29 tains any exclusion, reduction, or other limitations as to coverage,
30 deductibles, or coinsurance provisions, as to involuntary complications of
31 pregnancy, unless such provisions apply generally to all benefits paid under
32 the policy. If a fixed amount is specified in such policy for surgery, the
33 fixed amounts for surgical procedures involving involuntary complications of
34 pregnancy shall be commensurate with other fixed amounts payable for proce-
35 dures of comparable difficulty and severity. In a case where a fixed amount is
36 payable for maternity benefits, involuntary complications of pregnancy shall
37 be deemed an illness and entitled to benefits otherwise provided by the pol-
38 icy. Where the policy contains a maternity deductible, the maternity deduct-
39 ible shall apply only to expenses resulting from normal delivery and cesarean
40 section delivery; however, expenses for cesarean section delivery in excess of
41 the deductible shall be treated as expenses for any other illness under the
42 policy. This section shall apply to all disability policies except individual
43 noncancelable or guaranteed renewable policies, issued or delivered before
44 January 1, 1977.
45 With respect to such individual noncancelable or guaranteed renewable pol-
46 icies issued or delivered before January 1, 1977, the insurer shall communi-
47 cate the availability of coverage of involuntary complications of pregnancy
48 when negotiating any changes in such policies.
49 For purposes of this section, involuntary complications of pregnancy shall
50 include, but not be limited to, puerperal infection, eclampsia, cesarean sec-
51 tion delivery, ectopic pregnancy, and toxemia.
52 All policies subject to this section 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 policy which is in
55 conflict with this section shall be of no force or effect.
3
1 (4) From and after January 1, 1998, no policy of disability insurance
2 which provides medical expense maternity benefits, shall restrict benefits for
3 any hospital length of stay in connection with childbirth for the mother or
4 newborn child in a manner that would be in conflict with the newborns' and
5 mothers' health protection act of 1996.
6 SECTION 2. That Section 41-2210, Idaho Code, be, and the same is hereby
7 amended to read as follows:
8 41-2210. REQUIRED PROVISION IN GROUP AND BLANKET POLICIES. (1) Any group
9 disability insurance contract or blanket disability insurance contract, deliv-
10 ered or issued for delivery in this state which provides coverage for injury
11 or sickness for newborn dependent children of subscribers or other members of
12 the covered group, shall provide coverage for such newborn children, including
13 adopted newborn children that are placed with the adoptive subscriber or other
14 member of the covered group within sixty (60) days of the adopted child's date
15 of birth, from and after the moment of birth. Coverage under the contract for
16 an adopted newborn child placed with the adoptive subscriber or other member
17 of the covered group more than sixty (60) days after the birth of the adopted
18 child shall be from and after the date the child is so placed. Coverage pro-
19 vided in accord with this section shall include, but not be limited to, cover-
20 age for congenital anomalies, and shall also include those special medical
21 formulas which are approved by the director of the department of health and
22 welfare, prescribed by a physician, and are medically necessary for treatment
23 of phenylketonuria, tyrosinemia, homocystinuria, maple syrup urine disease,
24 propionic acidemia, or methylmalonic acidemia in infants and children or medi-
25 cally necessary to protect the unborn fetuses of pregnant women with phenylke-
26 tonuria. The dependent coverage of any such contract shall also provide cover-
27 age for medically necessary intervention services delivered by certified early
28 intervention specialists, as defined by the department of health and welfare
29 in rule and in accordance with applicable certification requirements; provided
30 however, the reimbursement of costs for such services shall have a maximum
31 benefit of three thousand five hundred dollars ($3,500) per year per child,
32 after which the department of health and welfare shall pay for such early
33 intervention services if the child otherwise qualifies. For the purposes of
34 this section, "child" means an individual who has not attained age eighteen
35 (18) years as of the date of the adoption or placement for adoption. For the
36 purposes of this section, "placed" shall mean physical placement in the care
37 of the adoptive subscriber or other member of the covered group, or in those
38 circumstances in which such physical placement is prevented due to the medical
39 needs of the child requiring placement in a medical facility, it shall mean
40 when the adoptive subscriber or other member of the covered group signs an
41 agreement for adoption of such child and signs an agreement assuming financial
42 responsibility for such child. Prior to legal finalization of adoption, the
43 coverage required under the provisions of this subsection (1) as to a child
44 placed for adoption with a subscriber or other member of the covered group
45 continues in the same manner as it would with respect to a naturally born
46 child of the subscriber or other member of the covered group until the first
47 to occur of the following events:
48 (a) Date the child is removed permanently from that placement and the
49 legal obligation terminates; or
50 (b) The date the subscriber or other member of the covered group
51 rescinds, in writing, the agreement of adoption or agreement assuming
52 financial responsibility.
53 (2) An insurer shall not restrict coverage under a group disability
4
1 insurance contract or a blanket disability insurance contract of any dependent
2 child adopted by a participant or beneficiary, or placed with a participant or
3 beneficiary for adoption, solely on the basis of a preexisting condition of a
4 child at the time the child would otherwise become eligible for coverage under
5 the plan, if the adoption or placement for adoption occurs while the partici-
6 pant or beneficiary is eligible for coverage under the plan.
7 (3) No policy of disability insurance which provides maternity benefits
8 for a person covered continuously from conception shall be issued, amended,
9 delivered, or renewed in this state on or after January 1, 1977, if it con-
10 tains any exclusion, reduction, or other limitations as to coverage,
11 deductibles, or coinsurance provisions, as to involuntary complications of
12 pregnancy, unless such provisions apply generally to all benefits paid under
13 the policy. If a fixed amount is specified in such policy for surgery, the
14 fixed amounts for surgical procedures involving involuntary complications of
15 pregnancy shall be commensurate with other fixed amounts payable for proce-
16 dures of comparable difficulty and severity. In a case where a fixed amount is
17 payable for maternity benefits, involuntary complications of pregnancy shall
18 be deemed an illness and entitled to benefits otherwise provided by the pol-
19 icy. Where the policy contains a maternity deductible, the maternity deduct-
20 ible shall apply only to expenses resulting from normal delivery and cesarean
21 section delivery; however, expenses for cesarean section delivery in excess of
22 the deductible shall be treated as expenses for any other illness under the
23 policy. This section shall apply to all disability policies except any group
24 disability policy made subject to an applicable collective-bargaining agree-
25 ment in effect before January 1, 1977.
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 SECTION 3. That Section 41-3437, Idaho Code, be, and the same is hereby
39 amended to read as follows:
40 41-3437. REQUIRED PROVISIONS -- INFANTS. (a) A subscriber's contract,
41 delivered or issued for delivery in this state which provides coverage for
42 injury or sickness for newborn dependent children of subscribers or other mem-
43 bers of the covered group, shall provide coverage for such newborn children,
44 including adopted newborn children that are placed with the adoptive sub-
45 scriber or other member of the covered group within sixty (60) days of the
46 adopted child's date of birth, from and after the moment of birth. Coverage
47 under the contract for an adopted newborn child placed with the adoptive sub-
48 scriber or other member of the covered group more than sixty (60) days after
49 the birth of the adopted child shall be from and after the date the child is
50 so placed. Coverage provided in accord with this section shall include, but
51 not be limited to, coverage for congenital anomalies, and shall also include
52 those special medical formulas which are approved by the director of the
53 department of health and welfare, prescribed by a physician, and are medically
5
1 necessary for treatment of phenylketonuria, tyrosinemia, homocystinuria, maple
2 syrup urine disease, propionic acidemia, or methylmalonic acidemia in infants
3 and children or medically necessary to protect the unborn fetuses of pregnant
4 women with phenylketonuria. The dependent coverage of any such contract shall
5 also provide coverage for medically necessary intervention services delivered
6 by certified early intervention specialists, as defined by the department of
7 health and welfare in rule and in accordance with applicable certification
8 requirements; provided however, the reimbursement of costs for such services
9 shall have a maximum benefit of three thousand five hundred dollars ($3,500)
10 per year per child, after which the department of health and welfare shall pay
11 for such early intervention services if the child otherwise qualifies. For the
12 purposes of this section, "child" means an individual who has not attained age
13 eighteen (18) years as of the date of the adoption or placement for adoption.
14 For the purposes of this section, "placed" shall mean physical placement in
15 the care of the adoptive subscriber or other member of the covered group, or
16 in those circumstances in which such physical placement is prevented due to
17 the medical needs of the child requiring placement in a medical facility, it
18 shall mean when the adoptive subscriber or other member of the covered group
19 signs an agreement for adoption of such child and signs an agreement assuming
20 financial responsibility for such child. Prior to legal finalization of adop-
21 tion, the coverage required under the provisions of this subsection as to a
22 child placed for adoption with a subscriber or other member of the covered
23 group continues in the same manner as it would with respect to a naturally
24 born child of the subscriber or other member of the covered group until the
25 first to occur of the following events:
26 (1) Date the child is removed permanently from that placement and the
27 legal obligation terminates; or
28 (2) The date the subscriber or other member of the covered group
29 rescinds, in writing, the agreement of adoption or agreement assuming
30 financial responsibility.
31 (b) A service corporation shall not restrict coverage under a
32 subscriber's contract of any dependent child adopted by a participant or bene-
33 ficiary, or placed with a participant or beneficiary for adoption, solely on
34 the basis of a preexisting condition of the child at the time the child would
35 otherwise become eligible for coverage under the plan, if the adoption or
36 placement for adoption occurs while the participant or beneficiary is eligible
37 for coverage under the plan.
38 SECTION 4. That Section 41-3923, Idaho Code, be, and the same is hereby
39 amended to read as follows:
40 41-3923. COVERAGE OF ADOPTED NEWBORN CHILDREN -- COVERAGE OF MATERNITY
41 AND COMPLICATIONS OF PREGNANCY. (1) Any contract delivered or issued for
42 delivery in this state by an organization offering a managed care plan for
43 which a certificate of authority is required, which provides coverage for
44 injury or sickness for newborn dependent children of the members of the cov-
45 ered group, shall provide such coverage for such newborn children and infants,
46 including adopted newborn children that are placed with the adoptive member of
47 the covered group within sixty (60) days of the adopted child's date of birth,
48 from and after the moment of birth. Coverage under the contract for an adopted
49 newborn child placed with the adoptive member of the covered group more than
50 sixty (60) days after the birth of the adopted child shall be from and after
51 the date the child is so placed. Coverage provided in accord with this section
52 shall include, but not be limited to, coverage for congenital anomalies, and
53 shall also include those special medical formulas which are approved by the
6
1 director of the department of health and welfare, prescribed by a physician,
2 and are medically necessary for treatment of phenylketonuria, tyrosinemia,
3 homocystinuria, maple syrup urine disease, propionic acidemia, or
4 methylmalonic acidemia in infants and children or medically necessary to pro-
5 tect the unborn fetuses of pregnant women with phenylketonuria. The dependent
6 coverage of any such contract shall also provide coverage for medically neces-
7 sary intervention services delivered by certified early intervention special-
8 ists, as defined by the department of health and welfare in rule and in accor-
9 dance with applicable certification requirements; provided however, the reim-
10 bursement of costs for such services shall have a maximum benefit of three
11 thousand five hundred dollars ($3,500) per year per child, after which the
12 department of health and welfare shall pay for such early intervention ser-
13 vices if the child otherwise qualifies. For the purposes of this section,
14 "child" means an individual who has not reached age eighteen (18) years as of
15 the date of the adoption or placement for adoption. For the purposes of this
16 section, "placed" shall mean physical placement in the care of the adoptive
17 member of the covered group, or in those circumstances in which such physical
18 placement is prevented due to the medical needs of the child requiring place-
19 ment in a medical facility, it shall mean when the adoptive member of the cov-
20 ered group signs an agreement for adoption of such child and signs an agree-
21 ment assuming financial responsibility for such child. Prior to legal
22 finalization of adoption, the coverage required under the provisions of this
23 subsection (1) as to a child placed for adoption with a member of the covered
24 group continues in the same manner as it would with respect to a naturally
25 born child of the member of the covered group until the first to occur of the
26 following events:
27 (a) Date the child is removed permanently from that placement and the
28 legal obligation terminates; or
29 (b) The date the member of the covered group rescinds, in writing, the
30 agreement of adoption or agreement assuming financial responsibility.
31 (2) The managed care organization shall not restrict coverage under a
32 health care contract of any dependent child adopted by a member, or placed
33 with a member for adoption, solely on the basis of a preexisting condition of
34 the child at the time the child would otherwise become eligible for coverage
35 under the plan, if the adoption or placement for adoption occurs while the
36 member is eligible for coverage under the plan.
37 (3) No health care contract which provides maternity benefits for a per-
38 son covered continuously from conception shall be issued, amended, delivered,
39 or renewed in this state if it contains any exclusion, reduction, or other
40 limitations as to coverage, deductibles, copayments, or coinsurance provisions
41 as to involuntary complications of pregnancy, unless such provisions apply
42 generally to all benefits paid under the plan. If a fixed amount is specified
43 in such plan for surgery, the fixed amounts for surgical procedures involving
44 involuntary complications of pregnancy shall be commensurate with other fixed
45 amounts payable for procedures of comparable difficulty and severity. In a
46 case where a fixed amount is payable for maternity benefits, involuntary
47 complications of pregnancy shall be deemed an illness and entitled to benefits
48 otherwise provided by the plan. Where the plan contains a maternity deduct-
49 ible, the maternity deductible shall apply only to expenses resulting from
50 normal delivery and cesarean section delivery; however, expenses for cesarean
51 section delivery in excess of the deductible shall be treated as expenses for
52 any other illness under the plan.
53 Where a plan which provides or arranges direct health care services for
54 its members contains a maternity deductible, the maternity deductible shall
55 apply only to expenses resulting from prenatal care and delivery. However,
7
1 expenses resulting from any delivery in excess of the deductible amount shall
2 be treated as expenses for any other illness under the plan. If the pregnancy
3 is interrupted, the maternity deductible charged for prenatal care and deliv-
4 ery shall be based on the value of the medical services received, providing
5 that it is never more than two-thirds (2/3) of the plan's maternity deduct-
6 ible.
7 This section shall apply to all health care contracts except any group
8 health care contracts made subject to an applicable collective-bargaining
9 agreement in effect before January 1, 1977.
10 For purposes of this section, involuntary complications of pregnancy shall
11 include, but not be limited to, puerperal infection, eclampsia, cesarean sec-
12 tion delivery, ectopic pregnancy, and toxemia.
13 All health care contracts subject to this section and issued, amended,
14 delivered, or renewed in this state on or after January 1, 1977, shall be con-
15 strued to be in compliance with this section, and any provision in any such
16 plan which is in conflict with this section shall be of no force or effect.
17 (4) From and after January 1, 1998, no policy of disability insurance
18 which provides medical expense maternity benefits shall restrict benefits for
19 any hospital length of stay in connection with childbirth for the mother or
20 newborn child in a manner that would be in conflict with the newborns' and
21 mothers' health protection act of 1996.
22 SECTION 5. That Section 41-4023, Idaho Code, be, and the same is hereby
23 amended to read as follows:
24 41-4023. COVERAGE FROM MOMENT OF BIRTH -- COMPLICATIONS OF PREGNANCY. (1)
25 Every self-funded plan issued in this state or providing coverage to any cov-
26 ered family residing within this state, shall contain a provision granting
27 immediate accident and sickness coverage, from and after the moment of birth,
28 to each newborn child or infant of any covered family covered, including a
29 newborn child placed with the adoptive covered family within sixty (60) days
30 of the adopted child's date of birth. Coverage under the self-funded plan for
31 an adopted newborn child placed with the adoptive covered family more than
32 sixty (60) days after the birth of the adopted child shall be from and after
33 the date the child is so placed. Coverage provided in accord with this section
34 shall include, but not be limited to, coverage for congenital anomalies, and
35 shall also include those special medical formulas which are approved by the
36 director of the department of health and welfare, prescribed by a physician,
37 and are medically necessary for treatment of phenylketonuria, tyrosinemia,
38 homocystinuria, maple syrup urine disease, propionic acidemia, or
39 methylmalonic acidemia in infants and children or medically necessary to pro-
40 tect the unborn fetuses of pregnant women with phenylketonuria. The dependent
41 coverage of any such self-funded plan shall also provide coverage for medi-
42 cally necessary intervention services delivered by certified early interven-
43 tion specialists, as defined by the department of health and welfare in rule
44 and in accordance with applicable certification requirements; provided how-
45 ever, the reimbursement of costs for such services shall have a maximum bene-
46 fit of three thousand five hundred dollars ($3,500) per year per child, after
47 which the department of health and welfare shall pay for such early interven-
48 tion services if the child otherwise qualifies. For the purposes of this sec-
49 tion, "child" means an individual who has not reached age eighteen (18) years
50 as of the date of the adoption or placement for adoption. For the purposes of
51 this section, "placed" shall mean physical placement in the care of the adop-
52 tive covered family, or in those circumstances in which such physical place-
53 ment is prevented due to the medical needs of the child requiring placement in
8
1 a medical facility, it shall mean when the adoptive covered family signs an
2 agreement for adoption of such child and signs an agreement assuming financial
3 responsibility for such child. Prior to legal finalization of adoption, the
4 coverage required under the provisions of this subsection (1) as to a child
5 placed for adoption with a covered family continues in the same manner as it
6 would with respect to a naturally born child of the covered family until the
7 first to occur of the following events:
8 (a) Date the child is removed permanently from that placement and the
9 legal obligation terminates; or
10 (b) The date the covered family rescinds, in writing, the agreement of
11 adoption or agreement assuming financial responsibility. No such plan may
12 be issued or amended if it contains any disclaimer, waiver, or other limi-
13 tation of coverage relative to the coverage or insurability of newborn or
14 adopted children or infants of a covered family covered from and after the
15 moment of birth that is inconsistent with the provisions of this section.
16 (2) An insurer shall not restrict coverage under a self-funded plan of
17 any dependent child adopted by a participant or beneficiary, or placed with a
18 participant or beneficiary for adoption, solely on the basis of a preexisting
19 condition of the child at the time the child would otherwise become eligible
20 for coverage under the plan, if the adoption or placement for adoption occurs
21 while the participant or beneficiary is eligible for coverage under the plan.
22 (3) No self-funded plan which provides maternity benefits for a person
23 covered continuously from conception shall be issued, amended, delivered, or
24 renewed in this state on or after January 1, 1977, if it contains any exclu-
25 sion, reduction, or other limitations as to coverage, deductibles, or coinsur-
26 ance provisions as to involuntary complications of pregnancy, unless such pro-
27 visions apply generally to all benefits paid under the plan. If a fixed amount
28 is specified in such plan for surgery, the fixed amounts for surgical proce-
29 dures involving involuntary complications of pregnancy shall be commensurate
30 with other fixed amounts payable for procedures of comparable difficulty and
31 severity. In a case where a fixed amount is payable for maternity benefits,
32 involuntary complications of pregnancy shall be deemed an illness and entitled
33 to benefits otherwise provided by the plan. Where the plan contains a mater-
34 nity deductible, the maternity deductible shall apply only to expenses result-
35 ing from normal delivery and cesarean section delivery; however, expenses for
36 cesarean section delivery in excess of the deductible shall be treated as
37 expenses for any other illness under the plan. This subdivision subsection
38 shall apply to all self-funded plans except any such plan made subject to an
39 applicable collective-bargaining agreement in effect before January 1, 1977.
40 For purposes of this subdivision subsection, involuntary complications of
41 pregnancy shall include, but not be limited to, puerperal infection,
42 eclampsia, cesarean section delivery, ectopic pregnancy, and toxemia.
43 All plans subject to this subdivision subsection and issued, amended,
44 delivered, or renewed in this state on or after January 1, 1977, shall be con-
45 strued to be in compliance with this section, and any provision in any such
46 plan which is in conflict with this section shall be of no force or effect.
REPRINT REPRINT REPRINT REPRINT
STATEMENT OF PURPOSE
RS 16010
This legislation will require certain disability insurance
contracts to provide coverage for special medical formulas and
early intervention services up to a specified benefit limit and
will make a technical correction, amending section 41-2210, Idaho
Code, to require certain group disability insurance contracts and
blanket disability insurance contracts to provide coverage for
special medical formulas and early intervention services up to a
specified limit. It will also amend section 41-3437, Idaho Code,
to require certain subscriber contracts to provide coverage for
special medical formulas and early intervention services up to a
specified benefit limit, amending section 41-3923, Idaho Code, to
require managed care organization plans to provide certain
coverage for special medical formulas and early intervention
services up to a specified benefit limit and to make a technical
correction; and amending section 41-4023, Idaho Code, to require
certain self-funded plans to provide certain coverage for special
medical formulas and early intervention services up to a
specified benefit limit and to make technical corrections.
FISCAL NOTE
The Infant and Toddler Program currently serves 384 children with
primary insurance coverage and 24 with secondary insurance
coverage. The estimated potential insurance receipts to this
program would be $1,428,000. There is one child with Maple Syrup
Urine Disease in Idaho who is currently not using state
assistance. There are 37 children enrolled in the Children's
Special Health Program with PKU. Insurance coverage for these
children would relieve this program of an estimated, maximum
amount of $740,000.
Contact
Name: Rep. Margaret Henbest
Rep. John Rusche
Phone: 332-1000
STATEMENT OF PURPOSE/FISCAL NOTE H 667