FINAL BILL REPORT

SSB 6433

                                  C 173 L 88

BYSenate Committee on Financial Institutions & Insurance (originally sponsored by Senators Rinehart, Johnson, Moore, Deccio and von Reichbauer)

Requiring health care insurance coverage for the food supplements necessary for the treatment of phenylketonuria.

Senate Committee on Financial Institutions & Insurance

House Committe on Financial Institutions & Insurance

SYNOPSIS AS ENACTED

BACKGROUND:

Insurers are not required to provide coverage for the formulas required in the treatment of phenylketonuria (PKU).  PKU is an inherited disorder found in newborn children which prevents them from metabolizing an essential amino acid.  If untreated, PKU children suffer severe mental and physical difficulties.

By taking a vitamin-enriched formula available without a doctor's prescription, the effects of PKU can be eliminated.

SUMMARY:

A disability insurance contract, group disability insurance contract, group contract for health care services or any group agreement for health care services delivered, issued for delivery or renewed on or after September 1, 1988, must provide coverage for the formulas necessary for the treatment of PKU.

The insurance commissioner is given rule making authority to establish requirements and exceptions for the mandated health care coverage.

Health maintenance organizations (HMOs) must provide coverage for the formulas when deemed medically necessary by the medical director of the HMO.  The formulas must be covered at the usual rate subject to the contract provisions of the HMO regarding deductibles and co-payments.

VOTES ON FINAL PASSAGE:

      Senate    45     0

      House 96   0

EFFECTIVE:March 22, 1988