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Indiana State Department of Health

Chronic Disease > Diabetes Prevention & Control Program > Health Insurance > Coverage for Services Related to Diabetes Coverage for Services Related to Diabetes

IC 27-8-14.5

An Act to amend the Indiana Code concerning insurance.

Be it enacted by the General Assembly of the State of Indiana:

SECTION 1. IC 27-8-14.5 IS ADDED TO THE INDIANA CODE AS A NEW
CHAPTER TO READ AS FOLLOWS [EFFECTIVE JANUARY 1, 1998]:

    Chapter 14.5. Coverage for Services Related to Diabetes
    Sec. 1.  As used in this chapter, "health insurance plan" means any:

      (1)  hospital or medical expense incurred policy or certificate;
      (2)  hospital or medical service plan contract; or
      (3)  health maintenance organization subscriber contract;
             provided to an insured.

(b)  The term does not include the following:

      (1)  Accident-only, credit, dental, vision, Medicare
             supplement, long term care, or disability income insurance
      (2)  Coverage issued as a supplement to liability insurance.
      (3)  Worker's compensation or similar insurance.
      (4)  Automobile medical payment insurance.
      (5)  A specified disease policy issued as an individual policy.
      (6)  A limited benefit health insurance policy issued as an
             individual policy.
      (7)  A short term insurance plan that:

        (A)  may not be renewed; and
        (B)  has a duration of not more than six (6) months.

      (8)  A policy that provides a stipulated daily, weekly, or
             monthly payment to an insured during hospital confinement,
             without regard to the actual expense of the confinement.      

    Sec. 2.  As used in this chapter, "insured" refers to an individual with:

      (1)  insulin-using diabetes;
      (2)  non-insulin using diabetes; or
      (3)  elevated blood glucose levels induced by pregnancy or
             another medical condition; who is covered by a health
             insurance plan issued by an insurer.

    Sec. 3.  As used in this chapter, "insurer" means any person
    who provides health insurance and issues health insurance plans
    in Indiana.  The term includes the following:

      (1)  A licensed insurance company.
      (2)  A prepaid hospital or medical service plan.
      (3)  A health maintenance organization.
      (4)  A state employee health benefit plan.
      (5)  The state Medicaid plan.
      (6)  Any person providing a plan of health insurance subject
             to state insurance law.

    Sec. 4.  A health insurance plan issued by an insurer must
    provide coverage to the insured for the medically necessary
    treatment for diabetes, including medically necessary supplies
    and equipment as ordered in writing by a physician licensed
    under IC 25-22.5 or a podiatrist licensed under IC 25-29, subject
    to the general provisions of the health insurance plan.

    Sec. 5.  (a)  An insured may not be required to pay an annual
    deductible or copayment that is greater than an annual
    deductible or copayment established for similar benefits under
    the health insurance plan.  If the plan does not cover a similar
    benefit, the co-payment or deductible may not be set at a level
    that materially diminishes the value of the diabetes benefit
    required by this chapter.

(b)  An insured may be subject to coinsurance that is not greater
than coinsurance established for similar benefits under the health
insurance plan.  If the plan does not cover a similar benefit, the
coinsurance may not be set at a level that materially diminishes the
value of the diabetes benefit required by this chapter.

    Sec. 6.  (a)  A health insurance plan issued by an insurer must provide
    coverage for diabetes self-management training that is:

      (1)  medically necessary;
      (2)  ordered in writing by a physician licensed under
             IC 25-22.5 or a podiatrist licensed under IC 25-29; and
      (3)  provided by a health care professional who:

        (A)  is licensed, registered, or certified under IC 25; and
        (B)  has specialized training in the management of diabetes.

   (b)  Coverage for diabetes self-management training may be limited to
   the following:

(1)  One (1) or more visits after receiving a diagnosis of diabetes.
(2)  One (1) or more visits after receiving a diagnosis by a
       physician licensed under IC 25-22.5 or a podiatrist licensed
       under IC 25-29 that:

(A)  represents a significant change in the insured's symptoms
       or condition; and
(B)  makes changes in the insured's self-management medically necessary.

(3)  One (1) or more visits for reeducation or refresher training.

    (c)  Coverage for diabetes self-management training is subject to the
    requirements of the health insurance plan regarding the use of
    participating providers.

    Sec. 7.  The department may adopt rules under IC 4-22-2 to carry out this chapter.

    SECTION 2.  [EFFECTIVE JANUARY 1, 1998] IC 27-8-14.5, as added by this act, applies to all health insurance plans (as defined in IC 27-8-14.5-1, as added by this act) issued or renewed after December 31, 1997.