Requiring health insurance coverage of amino-acid-based elemental formulas. (FE)

What it would have done

Summary by the Legislative Reference Bureau, the Legislature's nonpartisan drafting office. It's their wording, not ours.

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.

Who's behind it

7 lawmakers are its authors⁠. All 7 are Democrats.

3 more lawmakers signed on in support⁠.