§ 22:1077.3 — Required coverage for a patient's choice of medical and surgical treatments

Louisiana § 22:1077.3

• Jurisdiction: Louisiana
• Title 22: Insurance

Text

§1077.3. Required coverage for a patient's choice of medical and surgical treatments
following a diagnosis and treatment of cancer
A. The purpose of this Section is to stress that decisions regarding the treatment
procedures to be performed following a diagnosis of cancer shall be made solely by the
patient in consultation with attending physicians and to clarify that all levels of medical and
surgical treatment as provided for in this Section are medically necessary and shall not be
excluded from coverage. Consulting physicians shall consider recognized, evidence-based
standards such as the guidelines of the National Comprehensive Cancer Network in making
treatment recommendations.
B.(1) Any health benefit plan offered by a health insurance issuer that provides
medical and surgical benefits with respect to treatment for cancer shall provide coverage for
the medical and surgical treatment corresponding to urinary and sexual dysfunction resulting
from the treatments, chosen by a patient diagnosed with cancer in consultation with the
attending physician.
(2) A health benefit plan offered by a health insurance issuer that provides medical
and surgical benefits with respect to cancer treatment shall not deny coverage for those
procedures correcting urinary and sexual dysfunction resulting from treatments, including
penile injections, external pumps, and surgical implants, as chosen by a patient diagnosed
with and treated for cancer in consultation with the attending physician.
C. For purposes of this Section, the following terms have the following meanings:
(1) "Health benefit plan" means any hospital, health, or medical expense insurance
policy, hospital or medical service contract, employee welfare benefit plan, contract, or other
agreement with a health maintenance organization or a preferred provider organization,
health and accident insurance policy, or any other insurance contract of this type in this state,
including a group insurance plan and the Office of Group Benefits programs. "Health benefit
plan" does not include a plan providing coverage for excepted benefits as defined in R.S.
22:1061, limited benefit health insurance plans, and short-term policies that have a term of
less than twelve months.
(2) "Health insurance issuer" means an entity subject to the insurance laws and
regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or
offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of
healthcare services, including through a health benefit plan as defined in this Section, and
includes a sickness and accident insurance company, a health maintenance organization, a
preferred provider organization, or any similar entity, or any other entity providing a plan of
health insurance or health benefits.

Legislative History

Acts 2024, No. 621, §1.