An Act providing for certain health insurance coverage
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Overview
This bill expands health insurance coverage in Massachusetts to include the cost of enteral formulas for home use. Specifically, it requires certain health insurance policies – including those offered by the state, private accident and sickness insurers, and hospital service plans – to cover these formulas if a physician issues a written order stating they are medically necessary and have been proven effective for specific diseases. The bill also applies to medical service agreements and group health maintenance contracts.
Key provisions
- Requires private health insurance policies to cover the cost of medically necessary enteral formulas.
- Specifies diseases for which enteral formulas are considered medically necessary (e.g., inherited metabolic disorders, eosinophilic gastrointestinal disorders).
- Requires a written order from a physician to be included with the formula prescription.
- Applies to various types of health insurance plans, including those offered by the state, private insurers, and hospital service plans.
- Extends coverage to subscription certificates under medical service agreements.
- Includes coverage for group health maintenance contracts.
- Defines enteral formulas as distinct from nutritional supplements.
- Requires coverage for formulas administered orally or via tube feeding.
Who is affected
- Individuals with specific medical conditions requiring enteral formulas.
Bill text
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Sponsors
Official sponsors from legislative records.
3 on record
Primary sponsor
Joint Committee on Financial Services
Cosponsors
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