Indiana § 27-13-7-15.3 Breast cancer screening mammography

Indiana Statutes

§ 27-13-7-15.3 — Breast cancer screening mammography

Indiana § 27-13-7-15.3

Title 27INSURANCE

Art. 13HEALTH MAINTENANCE ORGANIZATIONS

Ch. 7Requirements for Group Contracts, Individual Contracts,

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Bluebook

Ind. Code § 27-13-7-15.3 (2026).

Text

3.

(a)As used in this section, "breast cancer screening mammography" has the meaning set forth in IC 27-8-14-2.

(b)As used in this section, "woman at risk" has the meaning set forth in IC 27-8-14-5.

(c)Except as provided in subsection (g), a health maintenance organization issued a certificate of authority in Indiana shall provide breast cancer screening mammography as a covered service under every group contract that provides coverage for basic health care services.

(d)Except as provided in subsection (g), the coverage that a health maintenance organization must provide under this section must include the following:

(1)If the enrollee is at least thirty-five (35) years of age but less than forty (40) years of age and a female, coverage for at least one

(1)baseline breast cancer scre

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3. (a) As used in this section, "breast cancer
screening mammography" has the meaning set forth in IC 27-8-14-2.
(b) As used in this section, "woman at risk" has the meaning set
forth in IC 27-8-14-5.
(c) Except as provided in subsection (g), a health maintenance
organization issued a certificate of authority in Indiana shall provide
breast cancer screening mammography as a covered service under
every group contract that provides coverage for basic health care
services.
(d) Except as provided in subsection (g), the coverage that a health
maintenance organization must provide under this section must include
the following:
(1) If the enrollee is at least thirty-five (35) years of age but less
than forty (40) years of age and a female, coverage for at least one
(1) baseline breast cancer screening mammography performed
upon the enrollee before the enrollee becomes forty (40) years of
age.
(2) If the enrollee is less than forty (40) years of age and a woman
at risk, one (1) breast cancer screening mammography performed
upon the enrollee every year.
(3) If the enrollee is at least forty (40) years of age and a female,
one (1) breast cancer screening mammography performed upon
the enrollee every year.
(4) Any additional mammography views that are required for
proper evaluation.
(5) Ultrasound services, if determined medically necessary by the
physician treating the enrollee.
(e) Except as provided in subsection (g), the coverage that a health
maintenance organization must provide under this section may not be
subject to a contract provision that is less favorable to an enrollee or a
subscriber than contract provisions applying to physical illness
generally under the health maintenance organization contract.
(f) Except as provided in subsection (g), the coverage that a health
maintenance organization must provide under this section is in addition
to services specifically provided for x-rays, laboratory testing, or
wellness examinations.
(g) In the case of coverage that is not employer based, the health
maintenance organization must offer to provide the coverage described
in subsections (c) through (f).