Montana Code 33-22-129. Coverage for treatment of diabetes — outpatient self-management training and education — limited benefit for medically necessary equipment and supplies — limitations on cost-sharing requirements for insulin
33-22-129. Coverage for treatment of diabetes — outpatient self-management training and education — limited benefit for medically necessary equipment and supplies — limitations on cost-sharing requirements for insulin. (1) Each group disability policy, certificate of insurance, and membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for outpatient self-management training and education for the treatment of diabetes. Any education must be provided by a licensed health care professional with expertise in diabetes.
Terms Used In Montana Code 33-22-129
- Contract: A legal written agreement that becomes binding when signed.
- Group health plan: means an employee welfare benefit plan, as defined in 29 U. See Montana Code 33-22-140
- Person: includes a corporation or other entity as well as a natural person. See Montana Code 1-1-201
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Montana Code 1-1-201
- United States: includes the District of Columbia and the territories. See Montana Code 1-1-201
(2)(a) Coverage must include an annual benefit for medically necessary and prescribed outpatient self-management training and education for the treatment of diabetes. At a minimum, the benefit must consist of:
(i)20 visits of training and education in diabetes self-management provided in either an individual or group setting if the person has not received the training and education previously; and
(ii)12 visits of followup diabetes self-management training and education services in subsequent years for an insured who has previously received and exhausted the initial 20 visits of education.
(b)Nothing in subsection (2)(a) prohibits an insurer from providing a greater benefit.
(c)For the purposes of this subsection (2), the term “visit” refers to a period of 30 minutes.
(3)(a) Each group disability policy, certificate of insurance, and membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for diabetic equipment and supplies that is limited to insulin, syringes, injection aids, devises for self-monitoring of glucose levels (including those for the visually impaired), test strips, visual reading and urine test strips, one insulin pump for each warranty period, accessories to insulin pumps, one prescriptive oral agent for controlling blood sugar levels for each class of drug approved by the United States food and drug administration, and glucagon emergency kits.
(b)Coverage for insulin must limit the insured’s required copayment or other cost-sharing requirement for insulin to $35 for up to a 30-day supply of insulin, regardless of the amount or type of insulin prescribed. The limitation in this subsection (3)(b) applies to insulin covered by the insurer’s or group health plan‘s formulary.
(4)Annual copayment and deductible provisions are subject to the same terms and conditions applicable to all other covered benefits within a given policy.
(5)This section does not apply to disability income, hospital indemnity, medicare supplement, accident-only, vision, dental, specific disease, or long-term care policies.
(6)(a) This section does not apply to any employee group insurance program of a city, town, county, school district, or other political subdivision of this state that on January 1, 2002, provides substantially equivalent or greater coverage for outpatient self-management training and education for the treatment of diabetes and certain diabetic equipment and supplies provided for in subsection (3).
(b)Any employee group insurance program of a city, town, county, school district, or other political subdivision of this state that reduces or discontinues substantially equivalent or greater coverage after January 1, 2002, is subject to the provisions of this section.