(a) On and after January 1, 2026, a health benefit plan that is offered, issued, renewed, delivered, or extended in this state shall provide coverage for medically necessary expenses for the treatment of diseases and conditions caused by severe obesity.
(b) The coverage under subsection (a) of this section shall include without limitation coverage for:(1) (A) Bariatric surgery as recognized by the American Society for Metabolic and Bariatric Surgery.(B) Bariatric surgery under subdivision (b)(1)(A) of this section shall be limited to the following:(i) Biliopancreatic bypass with duodenal switch;(ii) Laparoscopic adjustable gastric banding;(iii) Roux-en-Y procedure; and(iv) Sleeve gastrectomy;(2) Revision bariatric surgery when required to manage a complication resulting from a prior bariatric surgery type as provided in subdivision (b)(1) of this section that utilizes a different procedure from those procedures listed in subdivision (b)(1) of this section;(3) Preoperative care, including without limitation: (A) Psychological screening and counseling;(B) Behavior modification counseling;(C) Nutritional and dietary counseling; and(D) Exercise or physical therapy and counseling; and(4) Postoperative care, including without limitation:(A) Postoperative follow-up;(B) Behavior modification counseling;(C) Nutritional and dietary counseling;(D) Exercise or physical therapy and counseling; and (E) Psychological screening and counseling.(E) Psychological screening and counseling.
(1) (A) Bariatric surgery as recognized by the American Society for Metabolic and Bariatric Surgery.(B) Bariatric surgery under subdivision (b)(1)(A) of this section shall be limited to the following:(i) Biliopancreatic bypass with duodenal switch;(ii) Laparoscopic adjustable gastric banding;(iii) Roux-en-Y procedure; and(iv) Sleeve gastrectomy;
(A) Bariatric surgery as recognized by the American Society for Metabolic and Bariatric Surgery.
(B) Bariatric surgery under subdivision (b)(1)(A) of this section shall be limited to the following:(i) Biliopancreatic bypass with duodenal switch;(ii) Laparoscopic adjustable gastric banding;(iii) Roux-en-Y procedure; and(iv) Sleeve gastrectomy;
(i) Biliopancreatic bypass with duodenal switch;
(ii) Laparoscopic adjustable gastric banding;
(iii) Roux-en-Y procedure; and
(iv) Sleeve gastrectomy;
(2) Revision bariatric surgery when required to manage a complication resulting from a prior bariatric surgery type as provided in subdivision (b)(1) of this section that utilizes a different procedure from those procedures listed in subdivision (b)(1) of this section;
(3) Preoperative care, including without limitation: (A) Psychological screening and counseling;(B) Behavior modification counseling;(C) Nutritional and dietary counseling; and(D) Exercise or physical therapy and counseling; and
(B) Behavior modification counseling;
(C) Nutritional and dietary counseling; and
(D) Exercise or physical therapy and counseling; and
(4) Postoperative care, including without limitation:(A) Postoperative follow-up;(B) Behavior modification counseling;(C) Nutritional and dietary counseling;(D) Exercise or physical therapy and counseling; and (E) Psychological screening and counseling.(E) Psychological screening and counseling.
(A) Postoperative follow-up;
(B) Behavior modification counseling;
(C) Nutritional and dietary counseling;
(D) Exercise or physical therapy and counseling; and (E) Psychological screening and counseling.
(E) Psychological screening and counseling.
(c) For a covered person to qualify for coverage under this section:(1) A healthcare provider shall issue a written order that includes a statement that:(A) Identifies the body mass index and any associated comorbid conditions;(B) Describes the treatment plan for diseases and conditions caused by severe obesity; and(C) Attests that the treatment is medically necessary for the covered person according to the qualifications and treatment standards established by the American Society for Metabolic and Bariatric Surgery or the American College of Surgeons;(2) The covered person shall attest that he or she has:(A) Participated in a weight loss program;(B) Received preoperative medical and mental health evaluations and clearances;(C) Received preoperative education that addresses the risks, benefits, realistic expectations, and the need for long-term follow-up and adherence to behavioral modifications; and(D) Received a copy of the treatment plan that describes the preoperative needs and postoperative needs of an individual undergoing bariatric surgery;(3) In lieu of the list of requirements in subdivision (c)(2) of this section, a covered person may attest to the completion of a multidisciplinary surgical preparation program that is also signed by the healthcare provider; and(4) The covered person cannot have undergone a bariatric surgery previously, unless the proposed bariatric surgery is to correct a complication that resulted from the previous bariatric surgery.
(1) A healthcare provider shall issue a written order that includes a statement that:(A) Identifies the body mass index and any associated comorbid conditions;(B) Describes the treatment plan for diseases and conditions caused by severe obesity; and(C) Attests that the treatment is medically necessary for the covered person according to the qualifications and treatment standards established by the American Society for Metabolic and Bariatric Surgery or the American College of Surgeons;
(A) Identifies the body mass index and any associated comorbid conditions;
(B) Describes the treatment plan for diseases and conditions caused by severe obesity; and
(C) Attests that the treatment is medically necessary for the covered person according to the qualifications and treatment standards established by the American Society for Metabolic and Bariatric Surgery or the American College of Surgeons;
(2) The covered person shall attest that he or she has:(A) Participated in a weight loss program;(B) Received preoperative medical and mental health evaluations and clearances;(C) Received preoperative education that addresses the risks, benefits, realistic expectations, and the need for long-term follow-up and adherence to behavioral modifications; and(D) Received a copy of the treatment plan that describes the preoperative needs and postoperative needs of an individual undergoing bariatric surgery;
(A) Participated in a weight loss program;
(B) Received preoperative medical and mental health evaluations and clearances;
(C) Received preoperative education that addresses the risks, benefits, realistic expectations, and the need for long-term follow-up and adherence to behavioral modifications; and
(D) Received a copy of the treatment plan that describes the preoperative needs and postoperative needs of an individual undergoing bariatric surgery;
(3) In lieu of the list of requirements in subdivision (c)(2) of this section, a covered person may attest to the completion of a multidisciplinary surgical preparation program that is also signed by the healthcare provider; and
(4) The covered person cannot have undergone a bariatric surgery previously, unless the proposed bariatric surgery is to correct a complication that resulted from the previous bariatric surgery.