Current through Chapter 61 of the 2024 Legislative Session and 2024 Executive Orders 125, 133 through 135
Section 21.42.380 - Coverage for treatment of phenylketonuria(a) Except for a fraternal benefit society, a health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan shall provide coverage under the plan for the formulas necessary for the treatment of phenylketonuria. This subsection does not apply to a health care insurance plan that the director has determined by order should be excluded from this subsection.(b) A health care insurer providing coverage under this section may impose reasonable contract limitations but may not refuse coverage based on a preexisting condition of phenylketonuria or require that an individual covered under the plan pay a higher deductible or copayment for the cost of treating phenylketonuria than for the cost of treating another condition or illness.(c) In this section, "cost" means the lowest of the following: (1) the actual charge for the treatment received for phenylketonuria;(2) the usual, customary, and reasonable charge for the treatment as determined by the contract of coverage; or(3) the charge agreed to by contract between the treatment provider and the health care insurer.