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§ 764e. Reimbursement for diabetic supplies

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. InsuranceEffective: February 20, 2001

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 40 P.S. Insurance (Refs & Annos)
Chapter 2. Insurance Companies (Refs & Annos)
Article VI. Casualty Insurance (Refs & Annos)
(b) Health and Accident Insurance (Refs & Annos)
Effective: February 20, 2001
40 P.S. § 764e
§ 764e. Reimbursement for diabetic supplies
(a) Except to the extent already covered under another policy, any individual or group health, sickness and accident insurance policy, group health insurance plans/policies, and all other forms of managed/capitated care plans/policies or subscriber contract or certificate issued by any entity subject to 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63 (relating to professional health services plan corporations) or the act of December 29, 1972 (P.L. 1701, No. 364),1 known as the “Health Maintenance Organization Act,” the act of December 14, 1992 (P.L. 835, No. 134),2 known as the “Fraternal Benefit Societies Code,” or this act providing hospital or medical/surgical coverage shall provide coverage of the equipment, supplies and outpatient self-management training and education, including medical nutrition therapy for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and noninsulin-using diabetes if prescribed by a health care professional legally authorized to prescribe such items under law. The benefits specified in this section may be provided through a combination of policies, contracts, certificates or riders, including major medical contracts.
(b) This section does not include the following policies: accident only, fixed indemnity, limited benefit, credit, dental, vision, specified disease, Medicare supplement, CHAMPUS (Civilian Health and Medical Program for the Uniform Services) supplement, long-term care, disability income, workers' compensation or automobile medical payment.
(c) Equipment and supplies shall include the following: blood glucose monitors, monitor supplies, insulin, injection aids, syringes, insulin infusion devices, pharmacological agents for controlling blood sugar and orthotics.
(d) Diabetes outpatient self-management training and education shall be provided under the supervision of a licensed health care professional with expertise in diabetes to ensure that persons with diabetes are educated as to the proper self-management and treatment of their diabetes, including information on proper diets. Coverage for self-management education and education relating to diet and prescribed by a licensed physician shall include:
(1) visits medically necessary upon the diagnosis of diabetes;
(2) visits under circumstances whereby a physician identifies or diagnoses a significant change in the patient's symptoms or conditions that necessitates changes in a patient's self-management; and
(3) where a new medication or therapeutic process relating to the person's treatment and/or management of diabetes has been identified as medically necessary by a licensed physician.
(e) The coverage required under this section shall be subject to the annual deductibles, copayments or coinsurance requirements imposed by an entity subject to this section for similar coverages under the same health insurance policy or contract.

Credits

1921, May 17, P.L. 682, No. 284, § 634, added 1998, Oct. 16, P.L. 784, No. 98, § 1, effective in 120 days. Amended 2000, Dec. 20, P.L. 967, No. 132, § 2, effective in 60 days.

Footnotes

40 P.S. § 1551 et seq.
40 P.S. § 1142-101 et seq. (repealed); see 40 P.S. § 991.2401 et seq.
40 P.S. § 764e, PA ST 40 P.S. § 764e
Current through 2022 Regular Session Act 121. Some statute sections may be more current, see credits for details.
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