58-18B-56 Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--C...
Policies to provide coverage for diabetes supplies, equipment and education--Exceptions--Conditions and limitations.
Every small employer health benefit plan delivered, issued
for delivery, or renewed in this state, except for policies that provide coverage for specified disease
or other limited benefit coverage, shall provide, in writing, coverage for equipment, supplies, and
self-management training and education, including medical nutrition therapy, for treatment of
persons diagnosed with diabetes if prescribed by a physician or other licensed health care provider
legally authorized to prescribe such treatment. Medical nutrition therapy does not include any food
items or nonprescription drugs.
Coverage for medically necessary equipment and supplies shall include blood glucose monitors,
blood glucose monitors for the legally blind, test strips for glucose monitors, urine testing strips,
insulin, injection aids, lancets, lancet devices, syringes, insulin pumps and all supplies for the pump,
insulin infusion devices, prescribed oral agents for controlling blood sugars, glucose agents,
glucagon kits, insulin measurement and administration aids for the visually impaired, and other
medical devices for treatment of diabetes.
Diabetes self-management training and education shall be covered if: (a) the service is provided
by a physician, nurse, dietitian, pharmacist, or other licensed health care provider who satisfies the
current academic eligibility requirements of the National Certification Board for Diabetic Educators
and has completed a course in diabetes education and training or has been certified as a diabetes
educator; and (b) the training and education is based upon a diabetes program recognized by the
American Diabetes Association or a diabetes program with a curriculum approved by the American
Diabetes Association or the South Dakota Department of Health.
Coverage of diabetes self-management training is limited to (a) persons who are newly diagnosed
with diabetes or have received no prior diabetes education; (b) persons who require a change in
current therapy; (c) persons who have a co-morbid condition such as heart disease or renal failure;
or (d) persons whose diabetes condition is unstable. Under these circumstances, no more than two
comprehensive education programs per lifetime and up to eight follow-up visits per year need be
covered. Coverage is limited to the closest available qualified education program that provides the
necessary management training to accomplish the prescribed treatment.
The benefits provided in this section are subject to the same dollar limits, deductibles,
coinsurance, and other restrictions established for all other benefits covered in the plan.
Source: SL 1999, ch 252, § 5.