§2764. Coverage for medically necessary infant formula
(REALLOCATED FROM TITLE 24-A, SECTION 2763)
All individual health insurance policies, contracts and certificates must provide coverage for amino acid-based elemental infant formula for children 2 years of age and under in accordance with this section. [RR 2007, c. 2, §11 (RAL).]
1. Determination of medical necessity. Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has submitted documentation that the amino acid-based elemental infant formula is medically necessary health care as defined in section 4301‑A, subsection 10‑A, that the amino acid-based elemental infant formula is the predominant source of nutritional intake at a rate of 50% or greater and that other commercial infant formulas, including cow milk-based and soy milk-based formulas have been tried and have failed or are contraindicated. A licensed physician may be required to confirm and document ongoing medical necessity at least annually.
[RR 2007, c. 2, §11 (RAL).]
2. Method of delivery. Coverage for amino acid-based elemental infant formula must be provided without regard to the method of delivery of the formula.
[RR 2007, c. 2, §11 (RAL).]
3. Required diagnosis. Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has diagnosed and through medical evaluation has documented one of the following conditions:
A. Symptomatic allergic colitis or proctitis; [RR 2007, c. 2, §11 (RAL).]
B. Laboratory- or biopsy-proven allergic or eosinophilic gastroenteritis; [RR 2007, c. 2, §11 (RAL).]
C. A history of anaphylaxis; [RR 2007, c. 2, §11 (RAL).]
D. Gastroesophageal reflux disease that is nonresponsive to standard medical therapies; [RR 2007, c. 2, §11 (RAL).]
E. Severe vomiting or diarrhea resulting in clinically significant dehydration requiring treatment by a medical provider; [RR 2007, c. 2, §11 (RAL).]
F. Cystic fibrosis; or [RR 2007, c. 2, §11 (RAL).]
G. Malabsorption of cow milk-based or soy milk-based infant formula. [RR 2007, c. 2, §11 (RAL).]
[RR 2007, c. 2, §11 (RAL).]
4. Health savings accounts. Coverage for amino acid-based elemental infant formula under a health insurance policy, contract or certificate issued in connection with a health savings account as authorized under Title XII of the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003 may be subject to the same deductible and out-of-pocket limits that apply to overall benefits under the policy, contract or certificate.
[RR 2007, c. 2, §11 (RAL).]
SECTION HISTORY
RR 2007, c. 2, §11 (RAL).
Structure Maine Revised Statutes
TITLE 24-A: MAINE INSURANCE CODE
Chapter 33: HEALTH INSURANCE CONTRACTS
24-A §2703. Scope, format of policy
24-A §2704. Required provisions; captions -- omissions -- substitutions
24-A §2705. Entire contract -- changes
24-A §2706. Time limit on certain defenses
24-A §2712. Time of payment of claims
24-A §2713-A. Explanation and notice to parent
24-A §2714. Physical examination, autopsy
24-A §2716. Change of beneficiary
24-A §2717. Right to examine and return policy
24-A §2717-A. Disability benefit offsets
24-A §2718. Optional policy provisions
24-A §2719. Change of occupation
24-A §2720. Misstatement of age
24-A §2721. Overinsurance -- same insurer (REPEALED)
24-A §2721-A. Overinsurance in accident policies; same insurer
24-A §2721-B. Flight insurance limitation (REPEALED)
24-A §2722. Insurance with other insurers, provision of service or expense incurred basis
24-A §2723. Insurance with other insurers -- other benefits
24-A §2723-A. Coordination of benefits
24-A §2724. Relation of earnings to insurance
24-A §2726. Conformity with state statutes
24-A §2727. Illegal occupation
24-A §2728. Intoxicants and narcotics
24-A §2729-A. Limits on priority liens
24-A §2730. Order of certain provisions
24-A §2731. Third party ownership
24-A §2731-A. "Medically necessary mastectomy surgery" defined (REPEALED)
24-A §2732. Requirements of other jurisdictions
24-A §2733. Policies issued for delivery in another state
24-A §2734. Conforming to statute
24-A §2735-A. Notice of rate filing and rate increase
24-A §2736. Rate filings on individual health insurance policies
24-A §2736-C. Individual health plans
24-A §2737. Noncancellable disability insurance defined
24-A §2738. Notice as to renewability
24-A §2739. Lapse of policy, advance notice; limitation of action
24-A §2740. Franchise health insurance law (REPEALED)
24-A §2741-A. Mandated offer of domestic partner benefits
24-A §2742-A. Extension of coverage for dependent children
24-A §2742-B. Mandatory offer to extend coverage for dependent children up to 26 years of age
24-A §2742-C. Mandatory offer of coverage for certain adults with disabilities
24-A §2743. Newborn children coverage
24-A §2743-A. Maternity and routine newborn care
24-A §2743-B. Maternity and postpartum care
24-A §2744. Mental health services
24-A §2745. Home health care coverage
24-A §2745-A. Screening mammograms
24-A §2745-B. Acupuncture services
24-A §2745-C. Coverage for breast cancer treatment
24-A §2745-D. Medical food coverage for inborn error of metabolism
24-A §2745-E. Off-label use of prescription drugs for cancer
24-A §2745-F. Off-label use of prescription drugs for HIV or AIDS
24-A §2745-G. Coverage for prostate cancer screening (REALLOCATED FROM TITLE 24-A, SECTION 2745-E)
24-A §2746. Optional coverage for chiropractic services (REALLOCATED TO TITLE 24-A, SECTION 2840)
24-A §2747. Review and arbitration
24-A §2748. Coverage for chiropractic services
24-A §2749. Utilization review data
24-A §2749-A. Penalty for failure to notify of hospitalization
24-A §2749-B. Penalty for noncompliance with utilization review programs
24-A §2749-C. Mental health services coverage
24-A §2750. Acquired Immune Deficiency Syndrome
24-A §2752. Mandated health legislation procedures
24-A §2753. Standardized claim forms
24-A §2754. Coverage for diabetes supplies
24-A §2755. Assignment of benefits
24-A §2756. Coverage for contraceptives
24-A §2759. Coverage for hospice care services
24-A §2761. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery
24-A §2762. Coverage for hearing aids
24-A §2763. Coverage for colorectal cancer screening
24-A §2765. Coverage for services provided by independent practice dental hygienist
24-A §2765-A. Coverage for services provided by dental therapist
24-A §2766. Enrollment of dependent children in dental coverage
24-A §2766-A. Dental benefit waiting period