Coverage Under New York's Diabetes Insurance MandateBeginning in 1994, New York State began to require some health insurance policies reimburse for diabetes self-management education, equipment and supplies. The legislation was authored by Assemblyman Bob Sweeney and was signed into law as Chapter 378 of the Laws of 1993. This legislation is intended to help people with diabetes get access to the services and supplies they need to manage their disease.
Who is Covered?Persons who receive coverage from a comprehensive health insurance policy or health insurance policy that pays for outpatient services performed in a physician's office, and subscribers of a Health Maintenance Organization (HMO).
Exceptions to this are:
- Persons who receive health insurance benefits through Medicaid or Medicare.
- Employees or their dependents who receive health insurance coverage from:
- Employer sponsored benefit plans that are self-insured;
- Union sponsored welfare benefit plans;
- Benefit plans that insure employees who work in more than one state.
- While many employee benefit plans will voluntarily offer health insurance coverage even if they are not required by this mandate, please check with your benefits plan administrator to learn the type and scope of your plan.
What is Covered?
- Services provided by a nurse who is a certified diabetes educator for self- management education.
- Services provided by a NYS certified nutritionist or registered dietician for dietary counseling related to the control of diabetes.
- Equipment and supplies that are medically necessary and prescribed by a health care provider, e.g.:
- Blood glucose monitors, test strips and data management systems
- Control solutions used in blood glucose monitors
- Urine testing products for glucose and ketones
- Insulin Pumps including batteries and infusion devices
- All Insulin preparations, Glucagon, syringes & injection aids
- Lancets and automatic lancing devices
- Insulin cartridges, drawing up devices and monitors for the visually impaired
- Oral agents for the control of blood glucose
- All other services, supplies or equipment certified as appropriate by the Commissioner of the New York State Department of Health
How Much is Covered?The amount of coverage or reimbursement for the treatment of diabetes is subject to the deductibles, coinsurance and copayment requirements that are present for other benefits provided in the policy or HMO plan. Contact your insurance provider, HMO or plan administrator for details about these provisions.
When Do These Provisions Go Into Effect?The requirements of the Diabetes Insurance Mandate went into effect on January 1, 1994. It applies to all policies established, renewed or modified on or after that date. No action on your part is necessary for these provisions to be added to your policy.
Who Can I Get Help From If I Am Treated Unfairly?Most issues relating to HMO's are under the jurisdiction of the Department of Health. Complaints regarding how a HMO or its participating professionals provides a service, access to care, or access to needed supplies or equipment should be forwarded to:
Certification and Surveillance Unit
Bureau of Managed Care
NYS Department of Health
Corning Tower, Room 1911
Albany, NY 12237
Telephone (800) 206-8125
All other questions regarding HMO's or health insurance contracts fall under the jurisdiction of the Insurance Department. Complaints regarding a health insurance policy issued by a HMO or insurance company should be forwarded to:
Consumer Services Bureau
NYS Department of Insurance
Agency Building 1 - ESP
Albany, NY 12257
If you are interested in working towards similar laws in your state or would like information on how to organize a coalition to promote this type of legislation, please contact your local chapter of the American Diabetes Association, the American Association of Diabetes Educators, or David Holtzman, Esq. (Email: Holtzmanny@sprintmail.com).
Last Updated: Thursday February 06, 2003 12:53:30
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