§ 27-8-14-6 — Breast cancer screening mammography; coverage

(a) Except as provided in subsection (f), an
insurer must provide coverage for breast cancer screening
mammography in any accident and sickness insurance policy that the
insurer issues in Indiana.
(b) Except as provided in subsection (f), the coverage that an insurer
must provide under this section must include the following:
(1) If the insured is at least thirty-five (35) but less than forty (40)
years of age, coverage for at least one (1) baseline breast cancer
screening mammography performed upon the insured before she
becomes forty (40) years of age.
(2) If the insured is:
(A) less than forty (40) years of age; and
(B) a woman at risk;
one (1) breast cancer screening mammography performed upon
the insured every year.
(3) If the insured is at least forty (40) years of age, one (1) breast
cancer screening mammography performed upon the insured
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 insured.
(c) Except as provided in subsection (f), the coverage that an insurer
must provide under this section must provide reimbursement for breast
cancer screening mammography at a level at least as high as:
(1) the limitation on payment for screening mammography
services established in 42 CFR 405.534(b)(3) according to the
Medicare Economic Index at the time the breast cancer screening
mammography is performed; or
(2) the rate negotiated by a contract provider according to the
provisions of the insurance policy;
whichever is lower.
(d) Except as provided in subsection (f), the coverage that an insurer
must provide under this section may not be subject to dollar limits,
deductibles, or coinsurance provisions that are less favorable to the
insured than the dollar limits, deductibles, or coinsurance provisions
applying to physical illness generally under the accident and sickness
insurance policy.
(e) Except as provided in subsection (f), the coverage that an insurer
must provide is in addition to any benefits specifically provided for
x-rays, laboratory testing, or wellness examinations.
(f) In the case of insurance policies that are not employer based, the
insurer must offer to provide the coverage described in subsections (a)
through (e).

Legislative History

As added by P.L.119-1991, SEC.3. Amended by P.L.170-1999, SEC.3.