View Bill Status
View Bill Text
View Statement of Purpose / Fiscal Impact
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
]]]] 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
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