Islets of Hope state diabetes insurance coverage laws

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.

Federal Laws Pertaining to Persons with Diabetes

Diabetes Assistance Programs

New York - State Diabetes Insurance Coverage Laws

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New York has state-mandated laws that require insurance carriers to cover diabetes care and education services.

Insurance §3216i (15a); Chapter 378 of 1993 law - Requires coverage of "blood glucose monitors and blood glucose monitors for the visually impaired, data management systems, test strips for glucose monitors and visual reading and urine testing strips, insulin, injection aids, cartridges for the visually impaired, syringes, insulin pumps and appurtenances thereto, insulin infusion devices, and oral agents for controlling blood sugar; also include coverage for diabetes self-management education."

Summary of Provisions

• Requirement related to diabetes?  Yes
• Diabetes Education services covered?  Yes
• Medical nutritional therapy covered?  No
• Diabetes supplies covered?  Yes
• Specified supplies covered?  Yes

New York State Strategic Plan for the Prevention and Control of Diabetes

Private Health Insurance Plans

In January 1994 the diabetes insurance law became effective. Also known as Chapter 378 of the laws of 1993; (Insurance Law §§ 2221, #3216, #4303), this law states that medically necessary diabetes self-management education and education relating to diet* will be covered when it is provided by:

• A physician or other licensed health care provider legally authorized to prescribe treatment.
• Staff as part of an office visit for diabetes diagnosis or treatment
• Certified diabetes nurse educator
• Registered Dietitian
• Certified Nutritionist or Dietitian

*Coverage for self-management education and education relating to diet shall also include home visits when medically necessary

This law also requires insurance coverage for various diabetes equipment and related supplies. The list of equipment and related supplies which may be medically necessary for the treatment of diabetes includes but is not limited to the following items (regulatory authority: 10 NYCRR Subpart § 60-.3.1):

• Lancets and automatic lancing devices
• Glucose test strips
• Alcohol swabs, skin prep wipes and IV prep (for cleaning skin)
• Blood glucose monitors (e.g. glucometers)
• Blood glucose monitors for the visually impaired
• Control solutions used in blood glucose monitors
• Diabetes data management systems for management of blood glucose
• Urine testing products for glucose and ketones
• Insulin
• Insulin infusion devices
• Oral anti-diabetic agents used to reduce blood sugar levels
• Injection aids (e.g. insulin drawing-up devices for the visually impaired)
• Cartridges for the visually impaired
• Disposable injectable insulin cartridges and pen cartridges
• Other disposable injectable medication cartridges and pen needles used for diabetes therapies
• Oral agents for treating hypoglycemia (e.g. glucose tablets and gels)
• Glucagon emergency kits
• Syringes
• Insulin pumps, equipment and supplies for use of the pump (e.g. batteries, semi- permeable transparent dressings; insertion devices; insulin infusion sets; reservoirs; cartridges; clips; skin adhesive and skin adhesive remover; tools specific to prescribed pump)

Insurance coverage is:

• Not based on the type of diabetes or whether or not the patient uses insulin
• Subject to same deductibles/co-payments as required for similar types of benefits in the insurance policy or contract

This law applies to:

• All Health Maintenance Organizations (HMOs)
• Health insurance policies, which provide comprehensive or major medical coverage
• Health insurance policies, which cover outpatient services, performed in a physician's office

This law does not apply to:

• Medicaid Recipients
• Union-sponsored benefit plans that are self-insured
• Medicare or Medigap (Medicare supplemental policies) beneficiaries
• Plans which insure employees in more than one state
• Employer-sponsored benefit plans that are self-insured
• Health insurance policies which were not issued in New York State

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Page Updated  02/18/2007