(a) As used in this Code section, the term: (1) "Accident and sickness insurance benefit plan, policy, or
contract" means: (A) An individual accident and sickness insurance policy or
contract, as defined in Chapter 29 of this title; (B) A group or blanket accident and sickness insurance policy or
contract, as defined in Chapter 30 of this title; (C) An individual or group contract of the type issued by a
nonprofit hospital service corporation established under Chapter
19 of this title; (D) An individual or group contract of the type issued by a
health care plan established under Chapter 20 of this title; (E) An individual or group contract of the type issued by a
nonprofit medical service corporation established under Chapter
18 of this title; (F) An individual or group contract of the type issued by a
health maintenance organization established under Chapter 21 of
this title; (G) An individual or group contract of the type issued by a
fraternal benefit society; or (H) Any similar individual or group accident and sickness
benefit plan, policy, or contract. (2) "Approved clinical trial program for treatment of children's
cancer" means a Phase II and III prescription drug clinical trial
program in this state, as approved by the federal Food and Drug
Administration or the National Cancer Institute for the treatment
of cancer that generally first manifests itself in children under
the age of 19 and that: (A)(i) Tests new therapies, regimens, or combinations thereof
against standard therapies or regimens for the treatment of
cancer in children; (ii) Introduces a new therapy or regimen to treat recurrent
cancer in children; or (iii) Seeks to discover new therapies or regimens for the
treatment of cancer in children which are more cost effective
than standard therapies or regimens; and (B) Has been certified by and utilizes the standards for
acceptable protocols established by the: (i) Pediatric Oncology Group; (ii) Children's Cancer Group; or (iii) Commissioner as he or she may otherwise define such term
by rule and regulation after due notice, any required hearing,
and compliance with any other requirements of applicable law,
but only providing for such definition in a manner at least as
restrictive as that established in this Code section. (3) "Routine patient care costs" means those medically necessary
costs of blood tests, X-rays, bone scans, magnetic resonance
images, patient visits, hospital stays, or other similar costs
generally incurred by the insured party in connection with the
provision of goods, services, or benefits to dependent children
under an approved clinical trial program for treatment of
children's cancer which otherwise would be covered under the major
medical accident and sickness insurance benefit plan, policy, or
contract if such medically necessary costs were not incurred in
connection with an approved clinical trial program for treatment
of children's cancer. Routine patient care costs specifically
shall not include the costs of any clinical trial therapies,
regimens, or combinations thereof, any drugs or pharmaceuticals,
any costs associated with the provision of any goods, services, or
benefits to dependent children which generally are furnished
without charge in connection with such an approved clinical trial
program for treatment of children's cancer, any additional costs
associated with the provision of any goods, services, or benefits
which previously have been provided to the dependent child, paid
for, or reimbursed, or any other similar costs. It is
specifically the intent of this Code section not to relieve the
sponsor of a clinical trial program of financial responsibility
for accepted costs of such program. (4) "State health plan" means any health insurance plan
established for employees of the state under Article 1 of Chapter
18 of Title 45 or Chapter 4 of Title 49 to provide health care
services to state employees and indigents. (b) On and after July 1, 1998, any state health plan or any accident
and sickness insurance benefit plan, policy, or contract, by
whatever name called, that provides major medical coverage for
dependent children and which is issued, delivered, issued for
delivery, or renewed in this state on or after July 1, 1998, shall
provide coverage for routine patient care costs incurred in
connection with the provision of goods, services, and benefits to
such dependent children in connection with approved clinical trial
programs for the treatment of children's cancer with respect to
those dependent children who: (1) Are covered dependents under a state health plan or under the
major medical coverage of an accident and sickness insurance plan,
policy, or contract; (2) Have been diagnosed with cancer prior to their nineteenth
birthday; (3) Are enrolled in an approved clinical trial program for
treatment of children's cancer; and (4) Are not otherwise eligible for benefits, payments, or
reimbursements from any other third party payors or other similar
sources. (c) For purposes of this Code section, any exclusions, reductions,
or limitations as to coverages or any cost-sharing arrangements
provided for in a state health plan or in an accident and sickness
insurance benefit plan, policy, or contract which provides major
medical coverage for dependent children and which applies to any
benefits, payments, or reimbursements for routine patient care
provided to dependent children in connection with generally
recognized therapies or regimens for the treatment of children's
cancer shall also apply to such benefits, payments, or
reimbursements for any dependent child who is enrolled in an
approved clinical trial program for treatment of children's cancer. (d) Except as provided in subsections (b) and (c) of this Code
section, nothing in this Code section shall be construed to: (1) Prohibit a state health plan or an insurer, nonprofit
corporation, health care plan, health maintenance organization,
fraternal benefit society, or other person from issuing or
continuing to issue an accident and sickness insurance benefit
plan, policy, or contract which has benefits that are greater than
the minimum benefits required by this Code section or from issuing
or continuing to issue any accident and sickness insurance plan,
policy, or contract which provides benefits which are generally
more favorable to the insured than those required by this Code
section; or (2) Change the contractual relations between any insurer,
nonprofit corporation, health care plan, health maintenance
organization, fraternal benefit society, or other similar person
and their insureds or covered dependents by whatever name called. |