SD33 - Mandated Coverage for Morbid Obesity

  • Published: 2000
  • Author: Special Advisory Commission on Mandated Health Insurance Benefits
  • Enabling Authority: Code of Virginia - § 9-298

Executive Summary:
During the 1999 Session of the General Assembly, the Senate Committee on Commerce and Labor referred 1999 Senate Bill 770 (SB 770) to the Special Advisory Commission on Mandated Health Insurance Benefits (Advisory Commission). Senate Bill 770 is patroned by Senator Benjamin J. Lambert, III.

The Advisory Commission held a hearing on July 28, 1999 in Richmond to receive public comments on SB 770. In addition to the patron, 17 speakers addressed the proposals. Representatives from Commonwealth Surgeons Ltd., Richmond Surgical Group, a surgeon, and 11 concerned citizens spoke in favor of the bill. Representatives from the Virginia Association of Health Plans (VAHP) and the Health Insurance Association of America (HIAA) spoke in opposition to the bill. In addition, written comments in support of the bill were provided by Commonwealth Surgeons Ltd., Medical College of Virginia, two surgeons, and 73 concerned citizens. The VAHP, Virginia Chamber of Commerce, Virginia Manufacturers Association, and Trigon Blue Cross Blue Shield submitted comments in opposition to the bill.

At the August 24, 1999 meeting of the Advisory Commission, the patron of the bill, Senator Benjamin J. Lambert, III, submitted two options for the amendments of SB 770. The first option includes language that limits the coverage of morbid obesity. The amended bill requires coverage for the treatment of morbid obesity through gastric bypass surgery or such other methods as may be recognized by the National Institutes of Health (NIH) as effective for the long-term reversal of morbid obesity. The amended bill also clarifies the term morbid obesity. The bill defines “morbid obesity” as (i) a weight which is at least 100 pounds over or twice the ideal weight for frame, age, height, and gender as specified in the 1983 Metropolitan Life Insurance tables, or (ii) a body mass index (“BMI”) equal to or greater than 35 kilograms per meter squared with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes, or (iii) a BMI of 40 kilograms per meter squared without such comorbidity. As used herein, “BMI” equals weight in kilograms divided by height in meters squared. The amended bill also requires insurers, corporations and health maintenance organizations to offer and make available coverage for the treatment of morbid obesity.

The second option presented by the patron only revises the definition of morbid obesity. The amended bill requires coverage for the surgical treatment of morbid obesity. The amended bill also clarifies the term morbid obesity. The bill defines “morbid obesity” as a body mass index (“BMI”) equal to or greater than 35 kilograms per meter squared with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes or BMI of 40 kilograms per meter squared without such comorbidity. “BMI” equals weight in kilograms divided by height in meters squared.