§1035.  Inherited metabolic diseases; coverage for food products

A.  Any health, hospital, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, and a self-insurance plan that provides medical and surgical benefits, which is delivered, issued for delivery, or renewed in this state on or after January 1, 2002, shall provide coverage, subject to applicable deductibles, coinsurance, and copayments, for low protein food products for treatment of inherited metabolic diseases, if the low protein food products are medically necessary and, if applicable, are obtained from a source approved by the health insurance issuer, provided coverage will not be denied if the health insurance issuer does not approve a source.

B.  As used in this Section, the following words shall have the following meanings:

(1)  "Inherited metabolic disease" shall mean a disease caused by an inherited abnormality of body chemistry. Such diseases shall be limited to:

(a)  Glutaric Acidemia.

(b)  Isovaleric Acidemia (IVA).

(c)  Maple Syrup Urine Disease (MSUD).

(d)  Methylmalonic Acidemia (MMA).

(e)  Phenylketonuria (PKU).

(f)  Propionic Acidemia.

(g)  Tyrosinemia.

(h)  Urea Cycle Defects.

(2)  "Low protein food products" shall mean a food product that is especially 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.  Low protein food products shall not include a natural food that is naturally low in protein.

C.  Coverage provided pursuant to this Section shall not exceed eligible benefits of two hundred dollars per month.

D.  The provisions of this Section shall not apply to limited benefit and short-term health insurance policies or contracts.

Acts 2001, No. 1013, §1; Redesignated from R.S. 22:215.22 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011.