AB 920

This bill requires health insurance policies and plans that cover prescription

medication to cover amino-acid–based elemental formulas (formulas) that are used

for the diagnosis or treatment of certain specified allergies and gastrointestinal tract

disorders, as well as medically necessary services to administer the formulas. The

coverage is required only if a physician has diagnosed the insured or enrollee with

one of the specified allergies or gastrointestinal tract disorders and has issued a

written prescription for the formula for the treatment of the insured or enrollee.

The coverage requirement applies to both individual and group health

insurance policies and plans, including defined network plans and health care plans

operated by cooperative associations; to health care plans offered by the state to its

employees, including a self-insured plan; and to self-insured health plans of

counties, cities, towns, villages, and school districts. The requirement specifically

does not apply to limited-scope benefit plans, to policies covering only certain

specified diseases, to medicare replacement or supplement policies, or to long-term

care insurance policies. The required coverage may not be subject to any limitations,

exclusions, or cost-sharing provisions that do not apply generally under the policy

or plan to coverage of prescription medication or services for its administration.