Chapter 187

2009 -- H 5823 SUBSTITUTE B

Enacted 11/04/09

 

A N A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Representatives Slater, Segal, and Diaz

     Date Introduced: February 26, 2009

 

It is enacted by the General Assembly as follows:

 

     SECTION 1. Section 27-18-66 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

 

     27-18-66. Tobacco cessation programs. -- (a) Every individual or group health

insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after

January 1, 2007 2010, which provides medical coverage that includes coverage for physician

services in a physician's office, and every policy which provides major medical or similar

comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided

that if such medical coverage does not include prescription drug coverage, such contract, plan or

policy shall not be required to include coverage for prescription nicotine replacement therapy.

FDA approved smoking cessation medications.

      (b) As used in this section, smoking cessation treatment includes the use of an over-the-

counter (OTC) or prescription US Food and Drug Administration (FDA) approved nicotine

replacement therapy smoking cessation medication when used in accordance with FDA approval,

for not more than two (2) courses of medication of up to fourteen (14) weeks each, annually,

when recommended and prescribed by a prescriber who holds prescriptive privileges in the state

in which they are licensed, and used in combination with an annual outpatient benefit of eight (8)

sixteen (16) one-half (1/2) hour evidence based smoking cessation counseling sessions provided

by a qualified practitioner for each covered individual. Smoking cessation treatment may be

further defined redefined through regulation promulgated by the health insurance commissioner.,

in accordance with the most current clinical practice guidelines sponsored by the United States

department of health and human services or its component agencies.

      (c) Health insurance contracts, plans, or policies to which this section applies, may

impose copayments and/or deductibles for the benefits mandated by this section consistent with

the contracts', plans' or policies' copayments and/or deductibles for physician services and

medications. Nothing contained in this section shall impact the reimbursement, medical necessity

or utilization review, managed care, or case management practices of these health insurance

contracts, plans or policies.

      (d) This section shall not apply to insurance coverage providing benefits for:

      (1) Hospital confinement indemnity;

      (2) Disability income;

      (3) Accident only;

      (4) Long-term care;

      (5) Medicare supplement;

      (6) Limited benefit health;

      (7) Specified disease indemnity;

      (8) Sickness or bodily injury or death by accident or both; and

      (9) Other limited benefit policies.

 

      SECTION 2. Section 27-19-57 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

 

     27-19-57. Tobacco cessation programs. -- (a) Every individual or group health

insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after

January 1, 2007 2010, which provides medical coverage that includes coverage for physician

services in a physician's office, and every policy which provides major medical or similar

comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided

that if such medical coverage does not include prescription drug coverage, such contract, plan or

policy shall not be required to include coverage for prescription nicotine replacement therapy

FDA approved smoking cessation medications.

      (b) As used in this section, smoking cessation treatment includes the use of an over-the-

counter (OTC) or prescription US Food and Drug Administration (FDA) approved smoking

cessation medication, when used in accordance with FDA approval, for not more than two (2)

courses of medication of up to fourteen (14) weeks each, annually, nicotine replacement therapy,

when recommended and prescribed by a prescriber who holds prescriptive privileges in the state

in which they are licensed, and used in combination with an annual outpatient benefit of eight (8)

sixteen (16) one-half (1/2) hour evidence based smoking cessation counseling sessions provided

by a qualified practitioner for each covered individual. Smoking cessation treatment may be

further defined redefined through regulation promulgated by the health insurance commissioner

in accordance with the most current clinical practice guidelines sponsored by the United States

department of health and human services or its component agencies.

      (c) Health insurance contracts, plans, or policies to which this section applies, may

impose copayments and/or deductibles for the benefits mandated by this section consistent with

the contracts', plans' or policies' copayments and/or deductibles for physician services and

medications. Nothing contained in this section shall impact the reimbursement, medical necessity

or utilization review, managed care, or case management practices of these health insurance

contracts, plans or policies.

      (d) This section shall not apply to insurance coverage providing benefits for:

      (1) Hospital confinement indemnity;

      (2) Disability income;

      (3) Accident only;

      (4) Long-term care;

      (5) Medicare supplement;

      (6) Limited benefit health;

      (7) Specified disease indemnity;

      (8) Sickness or bodily injury or death by accident or both; and

      (9) Other limited benefit policies.

 

     SECTION 3. Section 27-20-53 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

 

     27-20-53. Tobacco cessation programs. -- (a) Every individual or group health

insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after

January 1, 2007 2010, which provides medical coverage that includes coverage for physician

services in a physician's office, and every policy which provides major medical or similar

comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided

that if such medical coverage does not include prescription drug coverage, such contract, plan or

policy shall not be required to include coverage for prescription nicotine replacement therapy

FDA approved smoking cessation medications.

      (b) As used in this section, smoking cessation treatment includes the use of an over-the-

counter (OTC) or prescription US Food and Drug Administration (FDA) smoking cessation

medication, when used in accordance with FDA approval, for not more than two (2) courses of

medication of up to fourteen (14) weeks each, annually, nicotine replacement therapy, when

recommended and prescribed by a prescriber who holds prescriptive privileges in the state in

which they are licensed, and used in combination with an annual outpatient benefit of eight (8)

sixteen (16) one-half (1/2) hour evidence based smoking cessation counseling sessions provided

by a qualified practitioner for each covered individual. Smoking cessation treatment may be

further defined redefined through regulation promulgated by the health insurance commissioner.,

in accordance with the most current clinical practice guidelines sponsored by the United States

department of health and human services or its component agencies.

      (c) Health insurance contracts, plans, or policies to which this section applies, may

impose copayments and/or deductibles for the benefits mandated by this section consistent with

the contracts', plans' or policies' copayments and/or deductibles for physician services and

medications. Nothing contained in this section shall impact the reimbursement, medical necessity

or utilization review, managed care, or case management practices of these health insurance

contracts, plans or policies.

      (d) This section shall not apply to insurance coverage providing benefits for:

      (1) Hospital confinement indemnity;

      (2) Disability income;

      (3) Accident only;

      (4) Long-term care;

      (5) Medicare supplement;

      (6) Limited benefit health;

      (7) Specified disease indemnity;

      (8) Sickness or bodily injury or death by accident or both; and

      (9) Other limited benefit policies.

 

     SECTION 4. Section 27-41-70 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

 

     27-41-70. Tobacco cessation programs. -- (a) Every individual or group health

insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after

January 1, 2007 2010, which provides medical coverage that includes coverage for physician

services in a physician's office, and every policy which provides major medical or similar

comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided

that if such medical coverage does not include prescription drug coverage, such contract, plan or

policy shall not be required to include coverage for prescription nicotine replacement therapy.

FDA approved smoking cessation medications.

     (b) As used in this section, smoking cessation treatment includes the use of an over-the-

counter (OTC) or prescription US Food and Drug Administration (FDA) approved smoking

cessation medication, when used in accordance with FDA approval, for not more than two (2)

courses of medication of up to fourteen (14) weeks each, annually, nicotine replacement therapy,

when recommended and prescribed by a prescriber who holds prescriptive privileges in the state

in which they are licensed, and used in combination with an annual outpatient benefit of eight (8)

sixteen (16) one-half (1/2) hour evidence based smoking cessation counseling sessions provided

by a qualified practitioner for each covered individual. Smoking cessation treatment may be

further defined redefined through regulation promulgated by the health insurance commissioner

in accordance with the most current clinical practice guidelines sponsored by the United States

department of health and human services or its component agencies.

      (c) Health insurance contracts, plans, or policies to which this section applies, may

impose copayments and/or deductibles for the benefits mandated by this section consistent with

the contracts', plans' or policies' copayments and/or deductibles for physician services and

medications. Nothing contained in this section shall impact the reimbursement, medical necessity

or utilization review, managed care, or case management practices of these health insurance

contracts, plans or policies.

      (d) This section shall not apply to insurance coverage providing benefits for:

      (1) Hospital confinement indemnity;

      (2) Disability income;

      (3) Accident only;

      (4) Long-term care;

      (5) Medicare supplement;

      (6) Limited benefit health;

      (7) Specified disease indemnity;

      (8) Sickness or bodily injury or death by accident or both; and

      (9) Other limited benefit policies.

 

     SECTION 5. This act shall take effect upon passage.

     

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LC02063/SUB B

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