Common use of Food and Food Products for Inherited Metabolic Diseases Clause in Contracts

Food and Food Products for Inherited Metabolic Diseases. We cover charges incurred for the therapeutic treatment of inherited metabolic diseases, including the purchase of medical foods (enteral formula) and low protein modified food products as determined to be medically necessary by a [Member’s] Practitioner. For the purpose of this benefit: “inherited metabolic disease” means a disease caused by an inherited abnormality of body chemistry for which testing is mandated by law; “low protein modified food product” means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be used under the direction of a Practitioner for the dietary treatment of an inherited metabolic disease, but does not include a natural food that is naturally low in protein; and “medical food” means a food that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and is formulated to be consumed or administered enterally under the direction of a Practitioner.