Maine Revised Statutes
Chapter 33: HEALTH INSURANCE CONTRACTS
24-A §2764. Coverage for medically necessary infant formula (REALLOCATED FROM TITLE 24-A, SECTION 2763)

§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

Maine Revised Statutes

TITLE 24-A: MAINE INSURANCE CODE

Chapter 33: HEALTH INSURANCE CONTRACTS

24-A §2701. Scope of chapter

24-A §2702. Short title

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 §2707. Grace period

24-A §2707-A. Notification prior to cancellation; restrictions on lapse or termination due to cognitive impairment or functional incapacity

24-A §2708. Reinstatement

24-A §2709. Notice of claim

24-A §2710. Claim forms

24-A §2711. Proofs of loss

24-A §2712. Time of payment of claims

24-A §2713. Payment of claims

24-A §2713-A. Explanation and notice to parent

24-A §2714. Physical examination, autopsy

24-A §2715. Legal actions

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 §2725. Unpaid premiums

24-A §2726. Conformity with state statutes

24-A §2727. Illegal occupation

24-A §2728. Intoxicants and narcotics

24-A §2729. Renewability

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. Age limit

24-A §2735-A. Notice of rate filing and rate increase

24-A §2736. Rate filings on individual health insurance policies

24-A §2736-A. Hearing

24-A §2736-B. Order

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. Maternity benefits for unmarried women policyholders and the minor dependents of policyholders with dependent or family coverage required

24-A §2741-A. Mandated offer of domestic partner benefits

24-A §2742. Child coverage

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 §2751. Assessment of mandated benefits proposals; studies of mandated benefits issues (REPEALED)

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 §2757. Coverage for services of certified nurse practitioners; certified midwives; certified nurse midwives (REALLOCATED FROM TITLE 24-A, SECTION 2756)

24-A §2758. Coverage for services provided by registered nurse first assistants (REALLOCATED FROM TITLE 24-A, SECTION 2756)

24-A §2759. Coverage for hospice care services

24-A §2760. Coverage for general anesthesia for dentistry (REALLOCATED FROM TITLE 24-A, SECTION 2759)

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 §2764. Coverage for medically necessary infant formula (REALLOCATED FROM TITLE 24-A, SECTION 2763)

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

24-A §2767. Coverage for children's early intervention services (REALLOCATED FROM TITLE 24-A, SECTION 2766)

24-A §2768. Coverage for the diagnosis and treatment of autism spectrum disorders (REALLOCATED FROM TITLE 24-A, SECTION 2766)

24-A §2769. Prescription synchronization

24-A §2770. Absolute discretion clauses