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From State College, Pennsylvania, USA:

Is it true that there is now a law in Pennsylvania that insurance companies are supposed to cover 100% of diabetes supplies?


You can check on the states that have enacted the law (30 so far) on the AADE website; there's an area called Insurance Reimbursement by State. Pennsylvania is listed.


Additional comments from David S. Holtzman, Esq.:

In 1998 the Pennsylvania legislature passed and Governor Ridge signed into law a bill which requires all comprehensive health plans and managed care organizations that are subject to state jurisdiction to cover diabetes education, equipment and supplies. The new law took effect in January 1999 and applies to policies as they renew in 1999 or to new policies. The plans must cover these items and services to the same extent that they cover services under the policy or contract. For example, if your health insurance policy cover 80% of a physicians office charge, requiring the patient to pay a 20% coinsurance, then the insurer must also cover 80% of the services of a diabetes education program. The same with strips, glucose monitors, insulin and other things that people with diabetes need.

Keep in mind that any annual deductible for your medical insurance policy also applies to the new coverage for diabetes treatments and supplies. If you belong to a managed care organization like an HMO or PPO, then the patient will be required to make the same level of copay for diabetes education and supplies that they would have to make for other services under the contract. So, if you pay a $10 copay for a physician's office visit, you can expect to pay $10 per diabetes education program session. If you pay a copay of $5 per prescription drug you can expect to pay the same for a monthly supply of strips or syringes. There are some group health plans and programs to which this law does not apply: Medicare, Medicaid, Union Welfare Benefit Plans (UAW, Teamsters, etc.) as well as self-insured or self-funded plans governed by ERISA. Also, some large corporations that employ people in several different states are exempt if they have only one group health contract for all their employees. Check with your company's benefits officer to learn if these exceptions apply to your coverage.


Original posting 28 Oct 1999
Posted to Social Issues: Insurance/Costs


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