1995 Alaska Statutes
TITLE 21 INSURANCE
Chapter 21.42. THE INSURANCE CONTRACT
Sec. 21.42.380. COVERAGE FOR TREATMENT OF PHENYLKETONURIA.

(a) An insurer authorized under AS 21.09 to offer, issue for delivery, deliver, or renew an individual or a group disability insurance policy for major medical coverage on an expense-incurred basis in the state, a hospital or medical service corporation authorized under AS 21.87 to offer or renew a group contract for major medical coverage in the state, or a health maintenance organization authorized under AS 21.86 to offer an enrollee contract to provide health care services on a prepaid basis shall provide coverage for the formulas necessary for the treatment of phenylketonuria. This subsection does not apply to

(1) a Medicare supplement insurance policy;

(2) long-term care insurance;

(3) an insurance policy regulated under 5 U.S.C. 8901 - 8914 or 42 U.S.C. 1395mm;

(4) an insurance policy that provides services or reimbursement exclusively for optometric or vision care, dental or orthodontic care, podiatric, ambulance, mental health, or chiropractic care;

(5) an insurance policy that the director has, in writing, determined should be excluded from this subsection.

(b) The insurer, hospital or medical service corporation, or health maintenance organization 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 the insured or subscriber 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,

(1) "copayment" means the portion of the cost to be paid by the insured, subscriber, or enrollee in excess of the deductible;

(2) "cost" means the lowest of the following:

(A) the actual charge for the treatment received for phenylketonuria;

(B) the usual, customary, and reasonable charge for the treatment as determined by the contract of coverage; or

(C) the charge agreed to by contract between the provider and the insurer, hospital or medical service corporation, or health maintenance organization;

(3) "deductible" means the portion of covered costs that must be incurred before benefits become payable;

(4) "long-term care insurance" has the meaning given in AS 21.53.200 ;

(5) "major medical coverage" means a disability insurance contract, a subscriber contract, or an enrollee contract that provides benefits for hospital and medical care with potential lifetime maximum benefits for the insured, subscriber, or enrollee of at least $10,000.