Florida Senate - 2019                                     SB 358
       
       
        
       By Senator Stargel
       
       
       
       
       
       22-00607A-19                                           2019358__
    1                        A bill to be entitled                      
    2         An act relating to health insurance coverage for
    3         enteral formulas; amending s. 627.42395, F.S.;
    4         revising criteria for the required coverage of enteral
    5         formulas under specified health insurance policies;
    6         requiring the state group insurance program to provide
    7         coverage for certain enteral formulas and amino-acid
    8         based elemental formulas; making technical changes;
    9         providing applicability; providing an effective date.
   10          
   11  Be It Enacted by the Legislature of the State of Florida:
   12  
   13         Section 1. Section 627.42395, Florida Statutes, is amended
   14  to read:
   15         627.42395 Coverage for certain prescription and
   16  nonprescription enteral formulas.—
   17         (1) Notwithstanding any other provision of law, any health
   18  insurance policy delivered or issued for delivery, to any person
   19  in this state or any group, blanket, or franchise health
   20  insurance policy delivered or issued for delivery in this state
   21  must shall make available to the policyholder as part of the
   22  application, for an appropriate additional premium, coverage for
   23  prescription and nonprescription enteral formulas for home use
   24  which are ordered or physician prescribed by a physician
   25  licensed under chapter 458 or chapter 459 as medically necessary
   26  for the treatment of inherited diseases of amino acid, organic
   27  acid, carbohydrate, or fat metabolism as well as malabsorption
   28  originating from congenital defects present at birth or acquired
   29  during the neonatal period. Coverage for inherited diseases of
   30  amino acid acids and organic acid metabolism must acids shall
   31  include food products modified to be low protein, in an amount
   32  not to exceed $2,500 annually for any insured individual,
   33  through the age of 24. This subsection section applies to any
   34  person or family notwithstanding the existence of any
   35  preexisting condition.
   36         (2) Notwithstanding subsection (1), the state group
   37  insurance program administered under s. 110.123 must provide
   38  coverage for prescription and nonprescription enteral formulas
   39  and amino-acid-based elemental formulas, regardless of the
   40  method of delivery or intake, for home use which are ordered or
   41  prescribed by a physician licensed under chapter 458 or chapter
   42  459 as medically necessary for the treatment of:
   43         (a) Eosinophilic disorders;
   44         (b) Food protein-induced enterocolitis syndrome;
   45         (c) Inherited diseases of amino acid, organic acid,
   46  carbohydrate, or fat metabolism; or
   47         (d) Malabsorption originating from congenital defects
   48  present at birth, acquired during the neonatal period, or
   49  diagnosed later in life.
   50         Section 2. The amendment to s. 627.42395, Florida Statutes,
   51  made by this act applies to health insurance policies and state
   52  group health insurance plans beginning on or after January 1,
   53  2020.
   54         Section 3. This act shall take effect July 1, 2019.