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1998 SESSION

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HB 1413 Health insurance; coverage for early intervention services.

Introduced by: Mary T. Christian | all patrons    ...    notes | add to my profiles

SUMMARY:

Accident and sickness insurance; coverage for early intervention services. Requires health insurers, health maintenance organizations and corporations providing accident and sickness subscription contracts to provide coverage for medically necessary early intervention services. "Early intervention services" means medically necessary speech and language therapy, occupational therapy, physical therapy, and assistive technology services and devices for dependents from birth to age three who are certified by the Department of Mental Health, Mental Retardation and Substance Abuse Services as eligible for services under Part H of the Individuals with Disabilities Education Act (20 U.S.C. § 1471 et seq.). "Medically necessary early intervention services for the population certified by the Department of Mental Health, Mental Retardation and Substance Abuse Services" means those services designed to help an individual attain or retain the capability to function age-appropriately within his environment, and includes services which enhance functional ability without effecting a cure. This coverage is limited to a benefit of $5,000 per insured or member per policy or calendar year. This bill also requires that the cost of these medically necessary early intervention services not be applied to any contractual provision limiting the total amount of coverage paid by the insurer to or on behalf of the insured during the insured's lifetime. Additionally, copayments, coinsurance or deductibles resulting from receiving early intervention services may be paid by federal, state, or local funds. The bill's provisions are applicable to policies, plans and contracts delivered, issued for delivery or renewed on and after July 1, 1998. They are not applicable to short-term travel, accident only, limited or specified disease policies, policies or contracts designed for issuance to persons eligible for coverage under Medicare, or to short-term nonrenewable policies of not more than six months' duration.


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