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I was wondering if anyone in NY or otherwise knowledgable could share their
experience with this Law.
I would certainly appreciate comment from any attorneys as well.
I have heard that it has been used to obtain reimbursment for gf food.
I will summarize!


http://assembly.state.ny.us/leg/?cl=52&a=21

NYS Insurance Law
Article 32 - Insurance Contracts-Life, Accident and Health, Annuities
Section 3216, paragraph 21

(21) Every policy which provides coverage for prescription drugs
shall include coverage for the cost of enteral formulas for home use for
which a physician or other licensed health care provider legally author-
ized to prescribe under title eight of the education law has issued a
written order. Such written order shall state that the enteral formula
is clearly medically necessary and has been proven effective as a
disease-specific treatment regimen for those individuals who are or will
become malnourished or suffer from disorders, which if left untreated,
cause chronic physical disability, mental retardation or death. Specific
diseases for which enteral formulas have been proven effective shall
include, but are not limited to, inherited diseases of amino acid or
organic acid metabolism; Crohn`s Disease; gastroesophageal reflux with
failure to thrive; disorders of gastrointestinal motility such as chron-
ic intestinal pseudo-obstruction; and multiple, severe food allergies
which if left untreated will cause malnourishment, chronic physical
disability, mental retardation or death. Enteral formulas which are
medically necessary and taken under written order from a physician for
the treatment of specific diseases shall be distinguished from nutri-
tional supplements taken electively. Coverage for certain inherited
diseases of amino acid and organic acid metabolism shall include modi-
fied solid food products that are low protein or which contain modified
protein which are medically necessary, and such coverage for such modi-
fied solid food products for any calendar year or for any continuous
period of twelve months for any insured individual shall not exceed two
thousand five hundred dollars.

Thank you,

Michael Thorn
Long Island/NY
Suffolk County Celiacs!

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