Texas § 1357.004 COVERAGE REQUIRED.

Texas Statutes

§ 1357.004 — COVERAGE REQUIRED.

Texas § 1357.004

Code INInsurance Code

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Bluebook

Tex. Insurance Code Code Ann. § 1357.004 (2026).

Text

Sec. 1357.004. COVERAGE REQUIRED.

(a)A health benefit plan that provides coverage for mastectomy must provide coverage for:

(1)reconstruction of the breast on which the mastectomy has been performed;

(2)surgery and reconstruction of the other breast to achieve a symmetrical appearance; and

(3)prostheses and treatment of physical complications, including lymphedemas, at all stages of mastectomy.

(b)Coverage required under this section:

(1)shall be provided in a manner determined to be appropriate in consultation with the attending physician and the enrollee;

(2)may be subject to annual deductibles, copayments, and coinsurance that are consistent with annual deductibles, copayments, and coinsurance required for other coverage under the health benefit plan; and

(3)may not be subject t

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Sec. 1357.004. COVERAGE REQUIRED. (a) A health benefit plan that provides coverage for mastectomy must provide coverage for:
(1) reconstruction of the breast on which the mastectomy has been performed;
(2) surgery and reconstruction of the other breast to achieve a symmetrical appearance; and
(3) prostheses and treatment of physical complications, including lymphedemas, at all stages of mastectomy.
(b) Coverage required under this section:
(1) shall be provided in a manner determined to be appropriate in consultation with the attending physician and the enrollee;
(2) may be subject to annual deductibles, copayments, and coinsurance that are consistent with annual deductibles, copayments, and coinsurance required for other coverage under the health benefit plan; and
(3) may not be subject to dollar limits other than the lifetime maximum benefits under the plan.