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| | SB0193 Engrossed | - 2 - | LRB100 05979 SMS 16007 b |
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1 | | coinsurance requirements or other limitations , waiting period, |
2 | | cost sharing limitation, treatment limitation, calendar year |
3 | | maximum, or other limitations as provided for
other physical or |
4 | | rehabilitative therapy benefits covered by the policy.
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5 | | A group or individual policy of accident and health |
6 | | insurance or managed care plan amended, delivered, issued, or |
7 | | renewed after the effective date of this amendatory Act of the |
8 | | 100th General Assembly shall offer an exception process from |
9 | | treatment limitations for individuals diagnosed with primary |
10 | | or secondary progressive multiple sclerosis. The exception |
11 | | process must be posted on the insurer's website in an |
12 | | easily-accessible location. An exception request must document |
13 | | medical necessity for extended treatment that is reasonable and |
14 | | appropriate to the individual's defined goals included in his |
15 | | or her treatment plan. A health insurer shall, within 72 hours |
16 | | after receiving the exception request, either approve or deny |
17 | | the request. |
18 | | The coverage required by this Section shall be subject to |
19 | | other general exclusions and limitations of the policy, |
20 | | including coordination of benefits, participating provider |
21 | | requirements, restrictions on services provided by family or |
22 | | household members, utilization review of health care services, |
23 | | including review of medical necessity, case management, |
24 | | experimental or investigational treatments, and other managed |
25 | | care provisions. |
26 | | (Source: P.A. 94-1076, eff. 12-29-06.)
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