Section 5-10-8-7.7 - Surgical treatment for morbid obesity(a) As used in this section, "covered individual" means an individual who is covered under a health care plan.(b) As used in this section, "health care plan" means:(1) a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or(2) a contract entered into under section 7(c) of this chapter to provide health services through a prepaid health care delivery plan.(c) As used in this section, "health care provider" means a: (1) physician licensed under IC 25-22.5; or(2) hospital licensed under IC 16-21; that provides health care services for surgical treatment of morbid obesity.
(d) As used in this section, "morbid obesity" means:(1) a body mass index of at least thirty-five (35) kilograms per meter squared, with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or(2) a body mass index of at least forty (40) kilograms per meter squared without comorbidity. For purposes of this subsection, body mass index is equal to weight in kilograms divided by height in meters squared.
(e) Except as provided in subsection (f), the state shall provide coverage for nonexperimental, surgical treatment by a health care provider of morbid obesity: (1) that has persisted for at least five (5) years; and(2) for which nonsurgical treatment that is supervised by a physician has been unsuccessful for at least six (6) consecutive months.(f) The state may not provide coverage for surgical treatment of morbid obesity for a covered individual who is less than twenty-one (21) years of age unless two (2) physicians licensed under IC 25-22.5 determine that the surgery is necessary to: (1) save the life of the covered individual; or(2) restore the covered individual's ability to maintain a major life activity (as defined in IC 4-23-29-6); and each physician documents in the covered individual's medical record the reason for the physician's determination.
As added by P.L. 78-2000, SEC.1. Amended by P.L. 196-2005, SEC.1; P.L. 102-2006, SEC.1.