40 Pa. Stat. § 3906

Current through Pa Acts 2024-53, 2024-56 through 2024-111
Section 3906 - Cost-sharing provisions
(a)Applicability.--Benefits for nutritional supplements (formulas) as medically necessary for the therapeutic treatment of phenylketonuria, branched-chain ketonuria, galactosemia and homocystinuria as administered under the direction of a physician shall be subject to copayment and coinsurance provisions of a health insurance policy to the extent that other medical services covered by the policy are subject to those provisions.
(a.1) Amino acid-based elemental medical formula.--Benefits for amino acid-based elemental medical formula ordered by a physician as medically necessary for food protein allergies, food protein-induced enterocolitis syndrome, eosinophilic disorders and short-bowel syndrome shall be subject to copayment and coinsurance provisions of a health insurance policy to the extent that other medical services covered by the policy are subject to those provisions.
(b) Exemption.--Benefits for nutritional supplements (formulas) as medically necessary for the therapeutic treatment of phenylketonuria, branched-chain ketonuria, galactosemia and homocystinuria as administered under the direction of a physician shall be exempt from deductible provisions in a health insurance policy. This exemption must be explicitly provided for in the policy.

40 P.S. § 3906

Amended by P.L. TBD 2014 No. 158, § 1, eff. 4/20/2015.
1996, Dec. 20, P.L. 1492, No. 191, § 6, effective June 20, 1997.