California Diabetes Insurance Laws | Diabetes Laws - California

Islets of Hope state diabetes insurance coverage laws

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Information for this article was compiled and edited by Lahle A. Wolfe, Islets of Hope.

Important Disclaimer

This information for general information purposes only.  

It is not intended to be used a recommendation or endorse- ment of any program or entity

This information is not intended to serve as any form of medical or legal advice.


Article Sources

National Conference of State Legislatures

Government Accountability Office (GAO) report number GAO-05-210 entitled "Managing Diabetes: Health Plan Coverage of Services and Supplies;" released on March 28, 2005.


State Laws Affecting Diabetes Care in Schools

Federal Laws Pertaining to Persons with Diabetes

Diabetes Assistance Programs


The Ehrlich Law Firm

Legal Counsel in California

If you live in the state of California, attorney Jeffrey I. Ehrlich can assist you in resolving disputes with your insurance company.

California law requires that your policy cover the following, when prescribed by your physican, even if the items are available without a prescription:

   (1) Blood glucose monitors and blood glucose testing strips.

   (2) Blood glucose monitors designed to assist the visually impaired.

   (3) Insulin pumps and all related necessary supplies.

   (4) Ketone urine testing strips.

   (5) Lancets and lancet puncture devices.

   (6) Pen delivery systems for the administration of insulin.

   (7) Podiatric devices to prevent or treat diabetes-related complications.

   (8) Insulin syringes.

   (9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.

If your insurance company is not covering tany of the above, please contact Jeffrey Ehrlich at  The Ehrlich Law Firm to see if your rights are being violated. There is no fee for the initial consultation, and no fee if there is no recovery (court ruling in your favor).


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Diabetes Laws

California - State Diabetes Insurance Coverage Laws


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California Laws Mandating Diabetes Coverage

Section 1367.51 of the Health and Safety Code;  SB 64 - signed 9/27/99 - expands a 1981 law to include equipment, supplies and drugs.  

SB 2094 of 2000 - signed 9/30/2000 - updates coverage to include outpatient daily self-management training, education and medical nutrition therapy services.

Summary of Provisions

  • Requirement related to diabetes? Yes
  • Diabetes Education services covered?  Yes
  • Medical nutritional therapy covered?  Yes
  • Diabetes supplies covered?  Yes
  • Specified supplies covered?  Yes

Cal. Health & Safety Code section 1367.51.


    (a) Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, and that covers hospital, medical, or surgical expenses shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:

   (1) Blood glucose monitors and blood glucose testing strips.
   (2) Blood glucose monitors designed to assist the visually impaired.
   (3) Insulin pumps and all related necessary supplies.
   (4) Ketone urine testing strips.
   (5) Lancets and lancet puncture devices.
   (6) Pen delivery systems for the administration of insulin.
   (7) Podiatric devices to prevent or treat diabetes-related complications.
   (8) Insulin syringes.
   (9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.

   (b) Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:

   (1) Insulin.
   (2) Prescriptive medications for the treatment of diabetes.
   (3) Glucagon.

   (c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.

   (d) Every plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollee's participating physician.  If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.

   (e) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (d) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service.  These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.

   (f) The copayments for the benefits specified in subdivision (d) shall not exceed those established for physician office visits by the plan.

   (g) Every health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plan's evidence of coverage and disclosure forms.

   (h) A health care service plan may not reduce or eliminate coverage as a result of the requirements of this section.

   (i) Nothing in this section shall be construed to deny or restrict in any way the department's authority to ensure plan compliance with this chapter when a plan provides coverage for prescription drugs.

 

Cal. Insurance Code section 10176.61.
 

  (a) Every insurer issuing, amending, delivering, or renewing a disability insurance policy on or after January 1, 2000, that covers hospital, medical, or surgical expenses shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items
are available without a prescription:

   (1) Blood glucose monitors and blood glucose testing strips.
   (2) Blood glucose monitors designed to assist the visually impaired.
   (3) Insulin pumps and all related necessary supplies.
   (4) Ketone urine testing strips.
   (5) Lancets and lancet puncture devices.
   (6) Pen delivery systems for the administration of insulin.
   (7) Podiatric devices to prevent or treat diabetes-related complications.
   (8) Insulin syringes.
   (9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.

   (b) Every insurer issuing, amending, delivering, or renewing a disability insurance policy on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:

   (1) Insulin.
   (2) Prescriptive medications for the treatment of diabetes.
   (3) Glucagon.

   (c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.

   (d) Every insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insured's participating physician.  If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.

   (e) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (d) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.

   (f) The coinsurances and deductibles for the benefits specified in subdivision (d) shall not exceed those established for physician office visits by the insurer.

   (g) Every disability insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurer's evidence of coverage and disclosure forms.

   (h) An insurer may not reduce or eliminate coverage as a result of the requirements of this section.

   (i) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy.

Nothing in this section may be construed as imposing a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.

 

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Page Updated  03/10/2007