Florida Senate - 2018                                     SB 528
       By Senator Stargel
       22-00354A-18                                           2018528__
    1                        A bill to be entitled                      
    2         An act relating to health insurance coverage for
    3         enteral formulas; amending s. 627.42395, F.S.;
    4         revising criteria for the required coverage of enteral
    5         formulas under specified health insurance policies;
    6         requiring the state group insurance program to provide
    7         coverage for certain enteral formulas and amino-acid
    8         based elemental formulas; specifying a limitation of
    9         such coverage by the state group insurance program;
   10         providing for future expiration; making technical
   11         changes; providing an effective date.
   13  Be It Enacted by the Legislature of the State of Florida:
   15         Section 1. Section 627.42395, Florida Statutes, is amended
   16  to read:
   17         627.42395 Coverage for certain prescription and
   18  nonprescription enteral formulas.—
   19         (1) Notwithstanding any other provision of law, any health
   20  insurance policy delivered or issued for delivery, to any person
   21  in this state or any group, blanket, or franchise health
   22  insurance policy delivered or issued for delivery in this state
   23  must shall make available to the policyholder as part of the
   24  application, for an appropriate additional premium, coverage for
   25  prescription and nonprescription enteral formulas for home use
   26  which are ordered or physician prescribed by a physician
   27  licensed under chapter 458 or chapter 459 as medically necessary
   28  for the treatment of inherited diseases of amino acid, organic
   29  acid, carbohydrate, or fat metabolism as well as malabsorption
   30  originating from congenital defects present at birth or acquired
   31  during the neonatal period. Coverage for inherited diseases of
   32  amino acid acids and organic acid metabolism must acids shall
   33  include food products modified to be low protein, in an amount
   34  not to exceed $2,500 annually for any insured individual,
   35  through the age of 24. This subsection section applies to any
   36  person or family notwithstanding the existence of any
   37  preexisting condition.
   38         (2) Notwithstanding subsection (1), the state group
   39  insurance program created under s. 110.123 must provide coverage
   40  for prescription and nonprescription enteral formulas and amino
   41  acid-based elemental formulas, regardless of the method of
   42  delivery or intake, for home use which are ordered or prescribed
   43  by a physician licensed under chapter 458 or chapter 459 as
   44  medically necessary for the treatment of eosinophilic disorders,
   45  food protein-induced enterocolitis syndrome, inherited diseases
   46  of amino acid, organic acid, carbohydrate, or fat metabolism as
   47  well as malabsorption originating from congenital defects
   48  present at birth or acquired during the neonatal period. Such
   49  coverage may not exceed an amount of $20,000 annually for any
   50  insured individual. This subsection expires December 31, 2021.
   51         Section 2. This act shall take effect January 1, 2019.