376.1232. Insurers to offer coverage for prosthetics.
Insurers to offer coverage for prosthetics.
376.1232. 1. Each health carrier or health benefit plan that offersor issues health benefit plans which are delivered, issued for delivery,continued, or renewed in this state on or after January 1, 2010, shalloffer coverage for prosthetic devices and services, including original andreplacement devices, as prescribed by a physician acting within the scopeof his or her practice.
2. For the purposes of this section, health carrier and healthbenefit plan shall have the same meaning as defined in section 376.1350.
3. The amount of the benefit for prosthetic devices and servicesunder this section shall be no less than the annual and lifetime benefitmaximums applicable to the basic health care services required to beprovided under the health benefit plan. If the health benefit plan doesnot include any annual or lifetime maximums applicable to basic health careservices, the amount of the benefit for prosthetic devices and servicesshall not be subject to an annual or lifetime maximum benefit level. Anyco-payment, coinsurance, deductible, and maximum out-of-pocket amountapplied to the benefit for prosthetic devices and services shall be no morethan the most common amounts applied to the basic health care servicesrequired to be provided under the health benefit plan.
4. The provisions of this section shall not apply to a supplementalinsurance policy, including a life care contract, accident-only policy,specified disease policy, hospital policy providing a fixed daily benefitonly, Medicare supplement policy, long-term care policy, short-term majormedical policies of six months or less duration, or any other supplementalpolicy as determined by the director of the department of insurance,financial institutions and professional registration.
(L. 2009 H.B. 577)