Minnesota Legislature
SF 930
as introduced - 91st Legislature (2019 - 2020) Posted on 02/07/2019 02:33pm
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A bill for an act
relating to health insurance; requiring coverage for treatments related to ectodermal
dysplasias; amending Minnesota Statutes 2018, sections 62A.25, subdivision 2;
62A.28, subdivision 2; proposing coding for new law in Minnesota Statutes, chapter
62A.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2018, section 62A.25, subdivision 2, is amended to read:
Subd. 2.
Required coverage.
(a) Every policy, plan, certificate or contract to which this
section applies shall provide benefits for reconstructive surgery when such service is
incidental to or follows surgery resulting from injury, sickness or other diseases of the
involved part or when such service is performed on a covered dependent child because of
congenital disease or anomaly which has resulted in a functional defect as determined by
the attending physician.
(b) The coverage limitations on reconstructive surgery in paragraph (a) do not apply to
reconstructive breast surgerynew text begin : (1)new text end following mastectomiesnew text begin ; or (2) if the patient has been
diagnosed with ectodermal dysplasia and has congenitally absent breast tissue or nipplesnew text end .
deleted text begin In these cases,deleted text end deleted text begin Coverage for reconstructive surgery must be provided if the mastectomy is
medically necessary as determined by the attending physician.
deleted text end
(c) Reconstructive surgery benefits include all stages of reconstruction deleted text begin of the breast on
which the mastectomy has been performeddeleted text end ,new text begin includingnew text end surgery and reconstruction of the
other breast to produce a symmetrical appearance, and prosthesis and physical complications
at all stages deleted text begin of a mastectomydeleted text end , including lymphedemas, in a manner determined in consultation
with the attending physician and patient. Coverage may be subject to annual deductible,
co-payment, and coinsurance provisions as may be deemed appropriate and as are consistent
with those established for other benefits under the plan or coverage. Coverage may not:
(1) deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage
under the terms of the plan, solely for the purpose of avoiding the requirements of this
section; and
(2) penalize or otherwise reduce or limit the reimbursement of an attending provider, or
provide monetary or other incentives to an attending provider to induce the provider to
provide care to an individual participant or beneficiary in a manner inconsistent with this
section.
Written notice of the availability of the coverage must be delivered to the participant upon
enrollment and annually thereafter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 2.
Minnesota Statutes 2018, section 62A.28, subdivision 2, is amended to read:
Subd. 2.
Required coverage.
Every policy, plan, certificate, or contract referred to in
subdivision 1 deleted text begin issued or renewed after August 1, 1987,deleted text end must provide coverage for scalp hair
prostheses worn for hair loss suffered as a result of alopecia areatanew text begin or ectodermal dysplasiasnew text end .
The coverage required by this section is subject to the co-payment, coinsurance,
deductible, and other enrollee cost-sharing requirements that apply to similar types of items
under the policy, plan, certificate, or contract and may be limited to one prosthesis per
benefit year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 3.
new text begin
[62A.3096] COVERAGE FOR ECTODERMAL DYSPLASIAS.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
For purposes of this chapter, "ectodermal dysplasias" means
a genetic disorder involving the absence or deficiency of tissues and structures derived from
the embryonic ectoderm.
new text end
new text begin Subd. 2. new text end
new text begin Coverage. new text end
new text begin
A health plan must provide coverage for the treatment of ectodermal
dysplasias.
new text end
new text begin Subd. 3. new text end
new text begin Dental coverage. new text end
new text begin
(a) A health plan must provide coverage for dental treatments
related to ectodermal dysplasias. Covered dental treatments must include but are not limited
to bone grafts, dental implants, orthodontia, dental prosthodontics, and dental maintenance.
new text end
new text begin
(b) If a dental treatment is eligible for coverage under a dental insurance plan or other
health plan, the coverage under this subdivision is secondary.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2020, and applies to health
plans offered, issued, or sold on or after that date.
new text end