Coverage for Diabetes Self-Management Training and Education

“Promoting a healthy economy and strong communities” BULLETIN B 04-02 TO: ALL HEALTH CARE INSURERS AUTHORIZED TO TRANSACT HEALTH INSURANCE IN THE STATE OF ALASKA AND OTHER INTERESTED PARTIES RE: COVERAGE FOR DIABETES SELF-MANAGEMENT TRAINING AND EDUCATION This bulletin is issued to clarify the coverage for treatment of diabetes required under AS 21.42.390. Many health care insurers are filing policy forms and some health care insurers may be issuing or renewing policies that contain a dollar limitation on diabetes outpatient selfmanagement training or education, which, as of January 1, 2003, is no longer allowed in this state. Please review AS 21.42.390 carefully to assure full compliance with the law. Effective July 27, 2000, AS 21.42.390(b) required all health care insurance plans to provide coverage for diabetes outpatient self-management training and education that is provided by a health care provider with training in the treatment of diabetes. The coverage required for diabetes outpatient self-management training or education under this law was not less than $1,500 per covered person per year. Effective January 1, 2003, AS 21.42.390(b) was repealed, effectively eliminating the $1,500 minimum. This means that a health care insurer may not offer, issue, or renew a health care insurance plan on or after January 1, 2003 that contains a dollar limitation on the coverage provided for diabetes outpatient self-management training or education. A health care insurer may continue to apply standard policy provisions, such as deductibles and copayments to this coverage. Health care insurance plans offered, issued, or renewed in Alaska that contain a dollar limitation on diabetes outpatient self-management training or education must be amended to remove that limitation and must be filed with the division for approval. A health care insurer that has limited benefits for diabetes outpatient self-management training or education on or after January 1, 2003 must reimburse each individual for whom these benefits were limited for any additional amount that would have been payable in the absence of the limitation. Dated this 26th of January, 2004 at Anchorage, Alaska. Linda S. Hall Director