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General Assembly Substitute Bill No. 317
January Session, 2019
AN ACT REQUIRING HEA LTH INSURANCE COVERA GE FOR
CERTAIN SURGICAL PRO CEDURES PERFORMED TO TREAT
SEVERE OBESITY.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective January 1, 2020) (a) For the purposes of 1
this section: 2
(1) "Body mass index" means the number calculated by dividing an 3
individual's weight in kilograms by the individual's height in meters 4
squared; and 5
(2) "Severe obesity" means a body mass index that is: 6
(A) Greater than forty; or 7
(B) Thirty-five or more if an individual has been diagnosed with a 8
comorbid disease or condition, including, but not limited to, a 9
cardiopulmonary condition, diabetes, hypertension or sleep apnea. 10
(b) Each individual health insurance policy providing coverage of 11
the type specified in subdivisions (1), (2), (4), (11) and (12) of section 12
38a-469 of the general statutes delivered, issued for delivery, renewed, 13
amended or continued in this state on or after January 1, 2020, shall 14
provide coverage for each surgical procedure that is: 15
(1) Performed to treat severe obesity, including, but not limited to, 16 Substitute Bill No. 317
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gastric bypass, sleeve gastrectomy and duodenal switch; 17
(2) Recognized by the National Institutes of Health, American 18
Society for Metabolic and Bariatric Surgery and American College of 19
Surgeons as providing long-term weight loss; and 20
(3) Consistent with guidelines issued by the National Institutes of 21
Health. 22
(c) The benefits required by this section shall be subject to the same 23
terms and conditions that apply to all other benefits covered under a 24
policy that is subject to this section. 25
Sec. 2. (NEW) (Effective January 1, 2020) (a) For the purposes of this 26
section: 27
(1) "Body mass index" means the number calculated by dividing an 28
individual's weight in kilograms by the individual's height in meters 29
squared; and 30
(2) "Severe obesity" means a body mass index that is: 31
(A) Greater than forty; or 32
(B) Thirty-five or more if an individual has been diagnosed with a 33
comorbid disease or condition, including, but not limited to, a 34
cardiopulmonary condition, diabetes, hypertension or sleep apnea. 35
(b) Each group health insurance policy providing coverage of the 36
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-37
469 of the general statutes delivered, issued for delivery, renewed, 38
amended or continued in this state on or after January 1, 2020, shall 39
provide coverage for each surgical procedure that is: 40
(1) Performed to treat severe obesity, including, but not limited to, 41
gastric bypass, sleeve gastrectomy and duodenal switch; 42
(2) Recognized by the National Institutes of Health, American 43 Substitute Bill No. 317
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Society for Metabolic and Bariatric Surgery and American College of 44
Surgeons as providing long-term weight loss; and 45
(3) Consistent with guidelines issued by the National Institutes of 46
Health. 47
(c) The benefits required by this section shall be subject to the same 48
terms and conditions that apply to all other benefits covered under a 49
policy that is subject to this section. 50
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2020 New section
Sec. 2 January 1, 2020 New section
Statement of Legislative Commissioners:
In Section 1(a)(2)(A) and Section 2(a)(2)(A), "kilograms per meter
squared" was deleted to avoid repetition; and Section 1(a)(2)(B) and
Section 2(a)(2)(B) were rewritten for clarity.
INS Joint Favorable Subst. -LCO