§ 23-99-405 — Mastectomies

(a) Every health benefit plan providing mastectomy benefits and issued or renewed after July 16, 2003, shall conform with the requirements of the Women's Health and Cancer Rights Act of 1998, 42 U.S.C. §§ 300gg-6 and 300gg-52 , as it existed on January 1, 2003. (b) To the extent the requirements of this section do not conflict with federal law, rules, or regulations, each healthcare insurer providing mastectomy benefits in a health benefit plan shall provide, in a manner determined in consultation with the attending physician and the enrollee or insured: (1) For medical and surgical benefits for any hospital stay in connection with a mastectomy for not less than forty-eight (48) hours unless the decision to discharge the patient before the expiration of the minimum length of stay is made by an attending physician in consultation with the enrollee or insured; (2) The following medical and surgical benefits with respect to mastectomy coverage if an enrollee or insured receives benefits in connection with a mastectomy and elects breast reconstruction: (A) Surgery and reconstruction of the breast on which the mastectomy has been performed; (B) Surgery and reconstruction of the other breast to produce a symmetrical appearance; and (C) Prostheses and coverage for physical complications at all stages of a mastectomy, including lymphedemas; and (3) Written notice of the availability of coverage under this section to the enrollee or insured upon enrollment and annually thereafter. (c) No healthcare insurer providing mastectomy benefits under this section shall: (1) Deny an enrollee or insured eligibility or continued eligibility to enroll or renew coverage under the terms of the health benefit plan solely for the purpose of avoiding the requirements of this section; or (2) Penalize, reduce, or limit the reimbursement of an attending provider or induce the provider to provide care in a manner inconsistent with this section.

Legislative History

Acts 1997, No. 1196, § 5; 2003, No. 179, § 1.