No. HB 977
Filed under Healthcare.
Benefits for Obesity under the State Group Health Insurance Plan; Requires DMS to provide coverage for treatment & management of obesity for state group health insurance policies issued after specified date; provides coverage criteria; requires department to adopt eligibility criteria by specified date; provides reporting requirements.
Plain English Summary
AI-GENERATEDStarting with policies issued in 2027, the State Group Health Insurance Plan must cover FDA-approved weight-loss medications and intensive behavioral treatment for obesity, when a health care provider prescribes it.
To qualify, an employee must be 18 or older, enrolled in a PPO or HMO, diagnosed with obesity by an in-network provider, and willing to share BMI and medical records with the department.
The department cannot impose stricter coverage rules for weight-loss medication than the FDA's own label allows, but it can still require patients to complete behavioral treatment before qualifying for drug coverage.
Starting in 2028, the department must report yearly to the Governor and legislative leaders on how many people used the benefit and how much money it saved enrollees and the state.
AIFor state health plan policies issued starting January 1, 2027, the department must cover FDA-approved weight management medications and intensive behavioral treatment for obesity when prescribed by a health care provider.
AICoverage rules for an FDA-approved weight management medication cannot be stricter than that medication's own FDA-approved indications, preventing the plan from adding extra hoops beyond the federal label.
AIBefore receiving the benefit, an employee must be at least 18, enrolled in a PPO or HMO plan, and referred and supervised by an in-network licensed provider, among other conditions the department must adopt by January 1, 2027.
AITo access this benefit, an employee must consent to provide personal and medical information to the department, including records documenting body mass index and any weight-related health conditions.
AIStarting January 15, 2028, and every year after, the department must report to the Governor and legislative leaders on how many people used the obesity benefit and how much it saved enrollees and the state.