17:48E-35.16 Coverage for treatment of inherited metabolic diseases by health service corporation.
3. No group or individual health service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, unless the contract provides benefits to each person covered thereunder for expenses incurred in the therapeutic treatment of inherited metabolic diseases, including the purchase of medical foods and low protein modified food products, when diagnosed and determined to be medically necessary by the covered person’s physician.
For the purposes of this section, “inherited metabolic disease” means a disease caused by an inherited abnormality of body chemistry for which testing is mandated pursuant to P.L.1977, C. 321 (C. 26:2-110. Policy declaration et seq.); “low protein modified food product” means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease, but does not include a natural food that is naturally low in protein; and “medical food” means a food that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and is formulated to be consumed or administered enterally under direction of a physician.
The benefits shall be provided to the same extent as for any other medical condition under the contract.
The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.
Original Text maintained by the State of New Jersey:
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