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1999 SESSION

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HB 1057 Health insurance; coverage for phenylketonuria.

Introduced by: Robert F. McDonnell | all patrons    ...    notes | add to my profiles

SUMMARY AS INTRODUCED:

Coverage for certain low protein formulas for individuals diagnosed as having phenylketonuria. Requires each (i) insurer issuing individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis, (ii) corporation providing individual or group accident and sickness subscription contracts, and (iii) health maintenance organization providing a health care plan for health care services, whose policy, contract or plan, including any certificate or evidence of coverage issued in connection with such policy, contract or plan, includes coverage for prescription drugs on an outpatient basis, to offer and make available coverage for low protein (low phenylalanine) formulas prescribed for the treatment of phenylketonuria and approved by the United States Food and Drug Administration for such treatment. The term "prescription drug" is deemed to include low protein formulas prescribed for the treatment of phenylketonuria; however, low protein formulas will not include commercial formulas which may be low in protein but have not been developed for the treatment of phenylketonuria. This new section will not require coverage for experimental drugs for phenylketonuria which are not approved by the United States Food and Drug Administration, or for prescription drugs in any contract, policy or plan that does not otherwise provide such coverage. This provision notes that closed formularies are not precluded so long as such formularies include low protein (low phenylalanine) formulas. This section will not apply to short-term travel, or accident-only policies, or to short-term nonrenewable policies of not more than six months' duration. The bill's provisions will apply to policies, contracts, and plans delivered, issued for delivery or renewed in Virginia on and after July 1, 1998.


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