Overview: S 965, Requires insurers to provide insurance coverage for rare diseases, life-threatening conditions or diseases, degenerative and disabling conditions, or diagnoses involving medically fragile children, REFERRED TO INSURANCE, Introduced on March 11, 2025.
Purpose and Intent: The bill aims to ensure that individuals with rare, life-threatening, degenerative, or disabling conditions, as well as medically fragile children, have access to necessary insurance coverage for their specialized healthcare needs.
Key Provisions:
- Mandates that all health insurance plans cover treatments, therapies, and medications for rare diseases, life-threatening conditions, degenerative and disabling conditions, and diagnoses involving medically fragile children
- Prohibits insurers from imposing annual or lifetime dollar limits on such coverage
- Requires insurers to provide an expedited appeals process for coverage determinations related to these conditions
Affected Parties and Impacts: Individuals with rare, life-threatening, degenerative, or disabling conditions, as well as parents of medically fragile children, would benefit from the expanded insurance coverage requirements. This could improve access to essential healthcare services and reduce financial burdens for affected families.
Procedural and Timeline Considerations: The bill has been referred to the Senate Committee on Insurance for review and consideration. If enacted, the new insurance coverage mandates would likely take effect for the next plan year, providing timely relief for those in need of specialized healthcare.
