Date:October 16, 2002
To:All Insurers Licensed to Transact the Business of Health Insurance in Wisconsin
From:Connie L. O'Connell, Commissioner of Insurance
Subject:Equipment and Supplies for the Treatment of Diabetes, s. 632.895(6), Wis. Stat.

2001 Wisconsin Act 82 amended s. 632.895(6) to include prescription drugs for the treatment of diabetes. In addition, the words "exclusions" and "limitations" were added to the second sentence of the statute. The amendments become generally effective on January 1, 2003. The current statute reads, in part, as follows. The amended language is in bold:

632.895 (6) Equipment and Supplies For Treatment of Diabetes.
Every disability insurance policy which provides coverage of expenses incurred for treatment of diabetes shall provide coverage for expenses incurred by the installation and use of an insulin infusion pump, coverage for all other equipment and supplies, including insulin or any other prescription medication, used in the treatment of diabetes, and coverage of diabetic self-management education programs. Coverage required under this subsection shall be subject to the same exclusions, limitations, deductibles, and coinsurance provisions of the policy as other covered expenses, except that . . .

The office has received a number of questions concerning the effect of this amendment on the coverage for prescription drugs for the treatment of diabetes. In particular, a question was raised about how this amendment will affect the coverage for prescription drugs for the treatment of diabetes under a Medicare supplement insurance policy. Since Medicare supplement insurance policies provide coverage for the treatment of diabetes, they will be required to provide coverage for prescription drugs for the treatment of diabetes. However, they may apply the same deductibles and coinsurance to these prescription drugs as they apply to prescription drugs under the policies in general. This means that, for those Medicare supplement policies that do not have a prescription drug rider, prescription drugs for the treatment of diabetes would be counted toward the $6,250 prescription drug deductible contained in the core benefit package with 80/20 coinsurance thereafter. For those Medicare supplement policies that have a prescription drug rider, the deductibles, coinsurance and coverage limitations in the rider would apply to the prescription drug coverage for the treatment of diabetes.

For non-Medicare supplement policies, the same deductibles, coinsurance amounts and limitations that apply to the policy's prescription drug coverage, if the policy covers prescription drugs, also apply to the prescription drug coverage for the treatment of diabetes. If the policy provides coverage for the treatment of diabetes, but does not cover prescription drugs, the policy must still cover prescription drugs for the treatment of diabetes. It may apply the deductible, coinsurance and coverage limitations that apply generally to other covered expenses. If the policy does not provide coverage for the treatment of diabetes, then it is not required to provide coverage for prescription drugs for the treatment of diabetes.

Any questions concerning this bulletin may be directed to Diane Dambach, Chief, Accident and Health Section at diane.dambach@wisconsin.gov.

Thank you.