40 Pa. Stat. § 3904

Current through Pa Acts 2024-53, 2024-56 through 2024-92
Section 3904 - Medical foods insurance coverage
(a)Nutritional supplements.--Except as provided in section 7, any health insurance policy which is delivered, issued for delivery, renewed, extended or modified in this Commonwealth by any health care insurer shall provide that the health insurance benefits applicable under the policy include coverage for the cost of nutritional supplements (formulas) as medically necessary for the therapeutic treatment of phenylketonuria, branched-chain ketonuria, galactosemia and homocystinuria as administered under the direction of a physician.
(b) Amino acid-based elemental medical formula.--Except as provided in section 7, any health insurance policy which is delivered, issued for delivery, renewed, extended or modified in this Commonwealth by any health care insurer shall provide that the health insurance benefits applicable under the policy include coverage for infants and children for the usual and customary cost of amino acid-based elemental medical formula ordered by a physician as medically necessary and administered orally or enterally for food protein allergies, food protein-induced enterocolitis syndrome, eosinophilic disorders and short-bowel syndrome. An amino acid-based elemental formula covered under this section is a formula made of 100% free amino acids as the protein source.

40 P.S. § 3904

Amended by P.L. TBD 2014 No. 158, § 1, eff. 4/20/2015.
1996, Dec. 20, P.L. 1492, No. 191, § 4, effective June 20, 1997.