Mandating insurance a catchy dating headline
APFED’s Guide to Formula Coverage provides helpful information for communicating with insurance companies.
In addition, if your state does not legislative mandated insurance coverage for elemental formula and you would like to help in our efforts with those states to enact legislation, please email APFED at [email protected]
The insured has been diagnosed with an eosinophilic gastrointestinal disorder. The insured is under the continuous supervision of a physician who is licensed pursuant to title 32, chapter 13 or 17 or a registered nurse practitioner who is licensed pursuant to title 32, chapter 15. There is risk of a mental or physical impairment without the use of the formula. An accountable health plan shall cover at least seventy‑five per cent of the cost of the formula. (c)(III)(A) Coverage for inherited enzymatic disorders caused by single gene defects involved in the metabolism of amino, organic, and fatty acids shall include, but not be limited to as well as severe protein allergic conditions includes, without limitation, the following diagnosed conditions: Phenylketonuria; maternal phenylketonuria; maple syrup urine disease; tyrosinemia; homocystinuria; histidinemia; urea cycle disorders; hyperlysinemia; glutaric acidemias; methylmalonic acidemia; and propionic acidemia; immunoglobulin E and nonimmunoglobulin E-mediated allergies to multiple food proteins; severe food protein induced enterocolitis syndrome; eosinophilic disorders as evidenced by the results of a biopsy; and impaired absorption of nutrients caused by disorders affecting the absorptive surface, function, length, and motility of the gastrointestinal tract.
The accountable health plan may limit the maximum annual benefit for formula under this section to twenty thousand dollars. In Colorado Revised Statutes, 10–16–104, amend (1)(c)(III)(A) and (1)(c)(III)(C) as follows: 10–16–104. Covered care and treatment of such conditions shall include, to the extent medically necessary, medical foods for home use for which a physician who is a participating provider has issued a written, oral, or electronic prescription.
In a self-funded plan, the employer has sole discretion as to which services will be covered and is only subject to federal law.Select your state: Arizona Colorado Connecticut Illinois Kansas Kentucky Maine Maryland Massachusetts Minnesota Missouri Nebraska New Hampshire New Jersey New York Oregon Pennsylvania Rhode Island South Dakota Texas Washington West Virginia A.