Enacts "Hannah's law"; requires certain insurance policies to include coverage for the cost of enteral formulas

1 Co-sponsor

• Ted O'Brien

BILL NUMBER:S2287A

Title of bill

An act to amend the insurance law, in relation to requiring certain health insurance policies to include coverage for the cost of enteral formulas whether administered orally or via tube feeding

Purpose

To update and modify existing laws requiring the coverage of enteral formulas.

Section 1: The short title Hannah's Law.

Sections 2-4: Respectively, the sections amend the following sections of the insurance law: Paragraph 21 of subsection (I) of section 3216, paragraph 11 of subsection (k) of section 3221, and subsection (y) of section 4303. Each section is amended to require that any insurance policy which covers medical, major medical, or comprehensive-type insurance also covers both oral and facing-tube administered enteral formulas.

Section 5: Makes a conforming amendment to Insurance law section 4322(b) (25), applicable to standardized individual enrollee direct payment contracts offered by health maintenance organizations.

Section 6: Provides the effective date.

Justification

Eosinophilic esophagitis is a life-threatening illness that makes it impossible to eat most foods. In such cases, patients can only receive nourishment from enteral formulas which may be administered orally or via a feeding tube. Most insurance companies, however, only cover the cost of administration via feeding tubes. This bill requires that both methods of administration be covered.

This bill was written in response to the case of Hannah De Vane, a six year-old girl with eosinophilic esophagitis. In Hannah's case, oral feeding is possible. Unfortunately, her family's insurance policy only covers the use of feeding tubes. As a result, her family must choose between feeding Hannah with a feeding tube or paying out-of-pocket for the more than $14,000 a year it costs to purchase and administer the prescription formula orally.

This bill will ensure adequate coverage for patients living with conditions such as eosinophilic esophagitis and other rare eosinoptilic disorders.

Legislative history

A.8413-A, 2011 and 2012 referred to insurance. Same as S.5034-A, 2011 referred to insurance and 2012 passed senate. A.2188, 2010 held for consideration in insurance; 2009, referred to insurance. Same as S. 628, 2010 and 2009 referred to insurance. A. 11219, 2008 referred to insurance.

Fiscal implications

To be determined.

Effective date

The bill shall be effective on the first of January following enactment and shall be applicable to all policies and

contracts issued, renewed, modified, altered or amended on or after such date.