PA 07-197—SB 66

Insurance and Real Estate Committee

Public Health Committee

Appropriations Committee

AN ACT EXPANDING INSURANCE COVERAGE FOR SPECIALIZED FORMULAS FOR CHILDREN

SUMMARY: This act requires health insurance policies to cover medically necessary specialized formulas administered under a physician's direction for children up to age 12, instead of age eight.

The act applies to group and individual insurance policies delivered, issued for delivery, or renewed in Connecticut after September 30, 2007 that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; (4) accidents only; and (5) hospital or medical services, including HMO contracts. It does not apply to self-insured benefit plans, which are regulated under the federal Employee Retirement Income Security Act (ERISA).

EFFECTIVE DATE: October 1, 2007

BACKGROUND

Specialized Formulas

“Specialized formula” is a nutritional formula that is exempt from the federal Food and Drug Administration's general nutritional labeling requirements and is intended for use solely under medical supervision in the dietary management of specific diseases.

Related Act

PA 07-75 requires insurers and HMOs to include a specified “medically necessary” definition in health insurance policies.

OLR Tracking: JLK: RC: JL: TS