(a)  Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2010, that provides medical coverage that includes coverage for physician services in a physician’s office, and every policy that provides major medical or similar comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided that if the medical coverage does not include prescription drug coverage, the contract, plan, or policy shall not be required to include coverage for FDA approved smoking cessation medications.

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

(b)  As used in this section, smoking cessation treatment includes the use of an over-the-counter (OTC) or prescription U.S. Food and Drug Administration (FDA) approved smoking cessation medication, when used in accordance with FDA approval, for not more than two (2) courses of medication of up to fourteen (14) weeks each, annually, when recommended and prescribed by a prescriber who holds prescriptive privileges in the state in which they are licensed, and used in combination with an annual outpatient benefit of sixteen (16) one-half (½) hour evidence-based smoking cessation counseling sessions provided by a qualified practitioner for each covered individual. Smoking cessation treatment may be redefined through regulation promulgated by the health insurance commissioner in accordance with the most current clinical practice guidelines sponsored by the United States Department of Health and Human Services or its component agencies.

(c)  Health insurance contracts, plans, or policies to which this section applies, may impose copayments and/or deductibles for the benefits mandated by this section consistent with the contracts’, plans’, or policies’ copayments and/or deductibles for physician services and medications. Nothing contained in this section shall impact the reimbursement; medical necessity or utilization review; managed care; or case management practices of these health insurance contracts, plans, or policies.

(d)  This section shall not apply to insurance coverage providing benefits for:

(1)  Hospital confinement indemnity;

(2)  Disability income;

(3)  Accident only;

(4)  Long-term care;

(5)  Medicare supplement;

(6)  Limited benefit health;

(7)  Specified disease indemnity;

(8)  Sickness or bodily injury or death by accident or both; and

(9)  Other limited benefit policies.