HB415 By Representative Johnson (R) RFD Commerce and Small Business Rd 1 15-MAR-16

SYNOPSIS: This bill would prohibit a health benefit plan that covers intravenous insulin infusion from requiring the insured to use a hospital instead of a medical clinic or office, or require a higher copayment, deductible, or coinsurance amount for the same intravenous insulin infusion regardless of the formulation or benefit category determination of the health benefit plan.

A BILL TO BE ENTITLED AN ACT

Relating to health insurance for intravenously administered insulin; to prohibit a health benefit plan that covers intravenous insulin infusion from requiring the insured to use a hospital instead of a medical clinic or office or require a higher copayment, deductible, or coinsurance amount for the same intravenous insulin infusion regardless of the formulation or benefit category determination of the health benefit plan.

BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:

Section 1. (a) As used in this section, the following words shall have the following meanings:

(1) CLINIC. Any medical clinic or physician's office containing facilities for the examination, diagnosis, treatment, or care of human illnesses that does not admit patients for overnight care. The term includes a rural clinic located in a medically underserved area or area that is not in an urbanized area as defined by the U.S. Census Bureau.

(2) HEALTH BENEFIT PLAN. An individual or group insurance policy or plan that covers hospital, medical, or surgical expenses or prescription drug benefits, a health maintenance organization, a preferred provider organization, a medical service organization, a physician-hospital organization, or any other person, firm, corporation, joint venture, or other similar business entity that pays for, purchases, or furnishes health care services to patients, insureds, or beneficiaries in this state. For the purposes of this section, a health benefit plan located or domiciled outside of the State of Alabama is deemed to be subject to this section if it receives, processes, adjudicates, pays, or denies claims for health care services submitted by or on behalf of patients, insureds, or beneficiaries who reside in the State of Alabama or who receive health care services in the State of Alabama. The term includes, but is not limited to, entities created pursuant to Article 6, Chapter 20, Title 10A, Code of Alabama 1975. The term does not include accident-only or disability income insurance, other limited benefit health insurance policies issued as a supplement to liability insurance, workers' compensation, or similar insurance, or automobile medical-payment insurance.

(3) HOSPITAL. Any licensed health care facility that admits patients for overnight care. The term does not include assisted living facilities, specialty care assisted living facilities, rehabilitation facilities, or sleep disorder centers.

(4) INTRAVENOUS INSULIN INFUSION. Intravenous delivery of any form of insulin.

(b) A health benefit plan that covers intravenous insulin infusion by a health care provider in a hospital, must cover intravenous insulin infusion by a health care provider in a clinic, and may not require a higher copayment, deductible, or coinsurance amount for intravenous insulin infusion in a clinic, regardless of the formulation or benefit category specified in the health benefit plan.

(c) A health benefit plan may not avoid compliance with subsection (b) by doing any of the following:

(1) Increasing the copayment, deductible, or coinsurance amount required for intravenous insulin infusion.

(2) Reclassifying benefits provided by the health benefit plan with respect to intravenous insulin infusion.

Section 2. This act shall become effective on the first day of the third month following its passage and approval by the Governor, or its otherwise becoming law.

Health Insurance

Diabetes

Health Benefit Plans

Health Care

Hospitals