Sec. 21.42.380. Coverage for treatment of phenylketonuria.
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Sec. 21.42.380. Coverage for treatment of phenylketonuria.
(a)Except for a fraternal benefit society, a health care insurer that offers, issues for delivery, delivers, or renews in this state a health care insurance plan shall provide coverage under the plan for the formulas necessary for the treatment of phenylketonuria. This subsection does not apply to a health care insurance plan that the director has determined by order should be excluded from this subsection.
(b)A health care insurer providing coverage under this section may impose reasonable contract limitations but may not refuse coverage based on a preexisting condition of phenylketonuria or require that an individual covered under the plan pay a higher deductible or copayment for the cost of treating phenylketonuria than for the cost of treating another condition or illness.
(c)In this section, “cost” means the lowest of the following:
(1)the actual charge for the treatment received for phenylketonuria;
(2)the usual, customary, and reasonable charge for the treatment as determined by the contract of coverage; or
(3)the charge agreed to by contract between the treatment provider and the health care insurer.