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1HB4152175510-13By Representative Johnson (R)4RFD: Commerce and Small Business 5First Read: 15-MAR-16 Page 0

1175510-1:n:03/10/2016:PMG/th LRS2016-10512 3 4 5 6 7 8SYNOPSIS: This bill would prohibit a health benefit9plan that covers intravenous insulin infusion from10requiring the insured to use a hospital instead of11a medical clinic or office, or require a higher12copayment, deductible, or coinsurance amount for13the same intravenous insulin infusion regardless of14the formulation or benefit category determination15of the health benefit plan.16 17A BILL18TO BE ENTITLED19AN ACT20 21Relating to health insurance for intravenously22administered insulin; to prohibit a health benefit plan that23covers intravenous insulin infusion from requiring the insured24to use a hospital instead of a medical clinic or office or25require a higher copayment, deductible, or coinsurance amount26for the same intravenous insulin infusion regardless of thePage 1

1formulation or benefit category determination of the health2benefit plan.3BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:4Section 1. (a) As used in this section, the5following words shall have the following meanings:6(1) CLINIC. Any medical clinic or physician's office7containing facilities for the examination, diagnosis,8treatment, or care of human illnesses that does not admit9patients for overnight care. The term includes a rural clinic10located in a medically underserved area or area that is not in11an urbanized area as defined by the U.S. Census Bureau. 12(2) HEALTH BENEFIT PLAN. An individual or group13insurance policy or plan that covers hospital, medical, or14surgical expenses or prescription drug benefits, a health15maintenance organization, a preferred provider organization, a16medical service organization, a physician-hospital17organization, or any other person, firm, corporation, joint18venture, or other similar business entity that pays for,19purchases, or furnishes health care services to patients,20insureds, or beneficiaries in this state. For the purposes of21this section, a health benefit plan located or domiciled22outside of the State of Alabama is deemed to be subject to23this section if it receives, processes, adjudicates, pays, or24denies claims for health care services submitted by or on25behalf of patients, insureds, or beneficiaries who reside in26the State of Alabama or who receive health care services in27the State of Alabama. The term includes, but is not limitedPage 2