Certain health and medical insurance contracts must cover treatment for cleft lip and cleft palate, including related secondary conditions; limited benefit policies are excluded.
§1026. Group, family group, blanket, and association health and accident insurance; cleft lip and cleft palate coverage; mandatory coverage A. Any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan, and a self-insurance plan that provides medical and surgical benefits which is delivered, issued for delivery or renewed in this state on or after January 1, 1998, shall include coverage for the treatment and correction of cleft lip and cleft palate. Such coverage shall also include benefits for secondary conditions and treatment attributable to that primary medical condition. Benefits shall include but not be limited to the following: (1) Oral and facial surgery, surgical management, and follow-up care. (2) Prosthetic treatment such as obturators, speech appliances, and feeding appliances. (3) Orthodontic treatment and management. (4) Preventive and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management or therapy. (5) Speech-language evaluation and therapy. (6) Audiological assessments and amplification devices. (7) Otolaryngology treatment and management. (8) Psychological assessment and counseling. (9) Genetic assessment and counseling for patient and parents. B. The provisions of this Section shall not apply to limited benefit health insurance policies or contracts authorized to be issued in this state. Acts 1989, No. 409, §1; Acts 1997, No. 1355, §1; Acts 2003, No. 129, §3, eff. May 28, 2003; Redesignated from R.S. 22:215.8 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011. NOTE: Former R.S. 22:1026 repealed by Acts 2008, No. 504, §2, eff. Jan.1, 2009, and redesignated as R.S. 22:806 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.