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SB 24 - Health Insurance - coverage for certain morbid obesity

Thomas, Nadine (10th)

Status Summary	SC:	I&L	HC:	Ins	FR:	01/15/99	LA:	04/22/99	Signed by Governor

First Reader Summary

A bill to amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to require health insurers to offer comprehensive medical or surgical coverage for the treatment of morbidly obese patients when said treatment is ordered, conducted, or supervised by health care providers specializing in the management of patients so afflicted.

Code Sections - 33-24-59.4

SB 24  99                                             SB24/AP 
 
      SENATE BILL 24 
 
      By:  Senator Thomas of the 10th 
 
 
                        A BILL TO BE ENTITLED 
                               AN ACT 
 
 
  1- 1  To amend Article 1 of Chapter 24 of Title 33 of the Official 
  1- 2  Code of Georgia Annotated, relating to insurance generally, 
  1- 3  so as to require health insurers to offer comprehensive 
  1- 4  medical or surgical coverage for the treatment of morbidly 
  1- 5  obese patients when said treatment is ordered, conducted, or 
  1- 6  supervised by health care providers specializing in the 
  1- 7  management of patients so afflicted; to provide for a short 
  1- 8  title; to provide for legislative findings; to provide 
  1- 9  definitions; to provide for the issuance of rules and 
  1-10  regulations by the Commissioner of Insurance; to provide for 
  1-11  adjustment of current contracts; to provide for related 
  1-12  matters; to repeal conflicting laws; and for other purposes. 
 
  1-13       BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: 
 
  1-14                           SECTION 1. 
 
  1-15  Article 1 of Chapter 24 of Title 33 of the Official Code of 
  1-16  Georgia Annotated, relating to insurance generally, is 
  1-17  amended by adding at the end thereof the following: 
 
  1-18    "33-24-59.4. 
 
  1-19    (a) This Code section shall be known and may be cited as 
  1-20    the 'Morbid Obesity Anti-discrimination Act.' 
 
  1-21    (b) The General Assembly finds and declares that: 
 
  1-22      (1) Whereas many health care insurers cover the costs of 
  1-23      treatment for patients diagnosed as morbidly obese by 
  1-24      their physicians, many other insurers refuse to cover 
  1-25      such costs; 
 
  1-26      (2) There is sufficient scientific data that implicate 
  1-27      morbid obesity as the cause of many other medical 
  1-28      problems and costly health complications, such as 
  1-29      diabetes, hypertension, heart disease, and stroke. 
  1-30      These data indirectly question the safety and 
  1-31      appropriateness of the continued refusal of some 
  1-32      insurers to cover the medically indicated treatment of 
  1-33      the morbidly obese patient.  The association of morbid 
 
 
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  2- 1      obesity with the aforementioned devastating diseases 
  2- 2      refutes any claim of a purely cosmetic indication for 
  2- 3      the treatment of morbid obesity and clearly designates 
  2- 4      morbid obesity as a life-threatening disease; 
 
  2- 5      (3) The cost of managing the complications of morbid 
  2- 6      obesity, largely due to inadequate treatment, far 
  2- 7      outweighs the cost of expeditious, effective medical 
  2- 8      treatment.  Therefore, insurers who continue to refuse 
  2- 9      to pay for the primary treatment of morbid obesity are 
  2-10      contributing to the high cost of management of secondary 
  2-11      complications; 
 
  2-12      (4) Guidelines developed by the National Institute of 
  2-13      Health, the American Society for Bariatric Surgery, the 
  2-14      American Obesity Association, and Shape Up America and 
  2-15      embraced by the American Medical Association and the 
  2-16      American College of Surgeons recommend that patients who 
  2-17      are morbidly obese receive responsible, affordable 
  2-18      medical treatment for their obesity; and 
 
  2-19      (5) The diagnosis of morbid obesity should be a clinical 
  2-20      decision made by a physician based on the guidelines set 
  2-21      by the appropriate health and medical associations and 
  2-22      organizations.  The treatment modality should also be a 
  2-23      clinical decision made by the physician based on set 
  2-24      guidelines. 
 
  2-25      (c)(1) As used in this Code section, the term: 
 
  2-26        (A) 'Health benefit policy' means any individual or 
  2-27        group plan, policy, or contract for health care 
  2-28        services issued, delivered, issued for delivery, or 
  2-29        renewed in this state which provides major medical 
  2-30        benefits, including those contracts executed by the 
  2-31        State of Georgia on behalf of indigents and on behalf 
  2-32        of state employees under Article 1 of Chapter 18 of 
  2-33        Title 45, by a health care corporation, health 
  2-34        maintenance organization, preferred provider 
  2-35        organization, accident and sickness insurer, fraternal 
  2-36        benefit society, hospital service corporation, medical 
  2-37        service corporation, or other insurer or similar 
  2-38        entity. 
 
  2-39        (B) 'Health care providers' means those physicians and 
  2-40        medical institutions that are specifically qualified 
  2-41        to treat in a comprehensive manner the entire complex 
  2-42        of illness and disease associated with morbid obesity. 
 
 
 
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  3- 1        (C) 'Insurer' means an accident and sickness insurer, 
  3- 2        fraternal benefit society, hospital service 
  3- 3        corporation, medical service corporation, health care 
  3- 4        corporation, health maintenance organization, or any 
  3- 5        similar entity authorized to issue contracts under 
  3- 6        this title and also means any state program funded 
  3- 7        under Title XIX of the federal Social Security Act, 42 
  3- 8        U.S.C.A. Section 1396 et seq., and any other publicly 
  3- 9        funded state health care program. 
 
  3-10        (D) 'Morbid obesity' means a weight which is at least 
  3-11        100 pounds over or twice the ideal weight for frame, 
  3-12        age, height, and gender as specified in the 1983 
  3-13        Metropolitan Life Insurance tables.  Morbid obesity 
  3-14        also means a body mass index (BMI) equal to or 
  3-15        greater than 35 kilograms per meter squared with 
  3-16        comorbidity or coexisting medical conditions such as 
  3-17        hypertension, cardiopulmonary conditions, sleep apnea, 
  3-18        or diabetes or a BMI of 40 kilograms per meter squared 
  3-19        without such comorbidity.  BMI equals weight in 
  3-20        kilograms divided by height in meters squared. 
 
  3-21      (2) Every health benefit policy that is delivered, 
  3-22      issued, executed, or renewed in this state or approved 
  3-23      for issuance or renewal in this state by the 
  3-24      Commissioner on or after July 1, 1999, which provides 
  3-25      major medical benefits may offer coverage for the 
  3-26      treatment of morbid obesity. 
 
  3-27    (d) The Commissioner of Insurance shall adopt rules and 
  3-28    regulations necessary to implement the provisions of this 
  3-29    Code section in collaboration with the Division of Public 
  3-30    Health of the Department of Human Resources and in 
  3-31    compliance with current guidelines established by 
  3-32    professional medical organizations relating to the 
  3-33    treatment of morbid obesity." 
 
  3-34                           SECTION 2. 
 
  3-35  All contracts relating to the provision of health care 
  3-36  services in effect on July 1, 1999, shall be appropriately 
  3-37  adjusted to reflect any change in services provided as 
  3-38  required by Section 1 of this Act. 
 
  3-39                           SECTION 3. 
 
  3-40  All laws and parts of laws in conflict with this Act are 
  3-41  repealed. 
 
 
 
 
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