LOU LEG Obesity Treatment Coverage


On May 31, LOU LEG passed bill on obesity treatment ins coverage.


  • LOU LEG passed bill SB 106 to add LOU LEG 22:1047 relative to obesity treatment.
  • Requires health insurers to provide coverage for certain severe obesity treatments.
  • Obesity Treatment
  • Health insurance issuer offering coverage will provide coverage for medically necessary expenses for diseases and conditions caused by severe obesity and treatment.
  • Sections C, D, E, and F applies only to a health insurance issuer offering health coverage plans as services are covered by Essential Health Benefits Benchmark Plan.
  • Department of Health will evaluate bariatric surgery, pre-operative psychological assessments, behavior modification, nutritional, diet and post-operative follow-ups.
  • Insured will be at least 18 years of age to be eligible for bariatric surgery coverage.
  • Physician will write an order stating that the treatment is medically necessary per American Society for Metabolic and Bariatric Surgery or American College of Surgeons.
  • Health insurance issuer may restrict covered services to facilities holding accreditation.
  • May require pre-operative treatment and prior authorization before bariatric surgery.
  • Bill provisions do not require health insurance issuer to provide coverage for injectable drugs used to lower glucose levels or any other drugs prescribed for weight loss.
  • Legislative History
  • On Mar. 11, 2024, bill introduced in Senate; on May 28, 2024, bill passed in Senate.
  • On Apr. 10, 2024, bill introduced in House; on May 21, 2024, bill was passed in House.
  • On May 31, 2024, bill delivered to governor for signature; pending governor review.
  • Effectiveness
  • If approved, bill SB 106 becomes effective as of Aug. 1, 2024, and will apply to any new policy, contract, program, or health coverage plan issued on or after Jan. 1, 2025.
  • Additionally, any policy, contract, or plan in effect prior to Jan. 1, 2025, will convert to conform this Act on or before the renewal date, but no later than Jan. 1, 2026.
  • Jun. 2024 LOU LEG Governor Approval
  • On Jun. 10, 2024, LOU LEG reported governor approved SB 106, assigned as Act 504.
  • Document dated Jun. 10, 2024, received from LOU LEG Jun. 15, summarized Jun. 19.

Regulators LOU LEG
Entity Types Ins
Reference Act 504, 6/10/2024; Bill SB106, 5/31/2024; Citation: LOU LEG 22;
Functions Claims/Accelerated Benefits; Compliance; Financial; Legal; Product Administration
Countries United States of America
Category
State
Products Insurance; Insurance-Health
Regions Am
Rule Type Final
Rule Date 5/31/2024
Effective Date 8/1/2024
Rule Id 214137
Linked to N/A
Reg. Last Update 6/10/2024
Report Section US Insurance

Last substantive update on 06/19/2024