IC 27-8-14
    Chapter 14. Coverage for Services Related to Breast CancerScreening

IC 27-8-14-1
"Accident and sickness insurance policy"
    Sec. 1. (a) As used in this chapter, "accident and sicknessinsurance policy" means an insurance policy that:
        (1) provides one (1) or more of the types of insurance describedin IC 27-1-5-1, classes 1(b) and 2(a); and
        (2) is issued on a group basis.
    (b) The term does not include the following:
        (1) Accident only, credit, dental, vision, Medicare supplement,long term care, or disability income insurance.
        (2) Coverage issued as a supplement to liability insurance.
        (3) Worker's compensation or similar insurance.
        (4) Automobile medical payment insurance.
        (5) A specified disease policy.
        (6) A short term insurance plan that:
            (A) may not be renewed; and
            (B) has a duration of not more than six (6) months.
        (7) A policy that provides indemnity benefits not based on anyexpense incurred requirement, including a plan that providescoverage for:
            (A) hospital confinement, critical illness, or intensive care;or
            (B) gaps for deductibles or copayments.
        (8) A supplemental plan that always pays in addition to othercoverage.
        (9) A student health plan.
        (10) An employer sponsored health benefit plan that is:
            (A) provided to individuals who are eligible for Medicare;and
            (B) not marketed as, or held out to be, a Medicaresupplement policy.
As added by P.L.119-1991, SEC.3. Amended by P.L.173-2007,SEC.30.

IC 27-8-14-2
"Breast cancer screening mammography"
    Sec. 2. (a) As used in this chapter, "breast cancer screeningmammography" means a standard, two (2) view per breast, low-doseradiographic examination of the breasts that is:
        (1) furnished to an asymptomatic woman; and
        (2) performed by a mammography services provider usingequipment designed by the manufacturer for and dedicatedspecifically to mammography in order to detect unsuspectedbreast cancer.
    (b) The term includes the interpretation of the results of a breastcancer screening mammography by a physician.As added by P.L.119-1991, SEC.3.

IC 27-8-14-3
"Insured"
    Sec. 3. As used in this chapter, "insured" means an individual whois entitled to coverage under a policy of accident and sicknessinsurance.
As added by P.L.119-1991, SEC.3.

IC 27-8-14-4
"Mammography services provider"
    Sec. 4. As used in this chapter, "mammography services provider"means a person or facility that:
        (1) has been accredited by the American College of Radiology;
        (2) meets equivalent guidelines established by the statedepartment of health; or
        (3) certified by the Federal Department of Health and HumanServices for participation in the Medicare program (42 U.S.C.1395 et seq.).
As added by P.L.119-1991, SEC.3. Amended by P.L.2-1992,SEC.787.

IC 27-8-14-5
"Woman at risk"
    Sec. 5. As used in this chapter, "woman at risk" means a womanwho meets at least one (1) of the following descriptions:
        (1) A woman who has a personal history of breast cancer.
        (2) A woman who has a personal history of breast disease thatwas proven benign by biopsy.
        (3) A woman whose mother, sister, or daughter has had breastcancer.
        (4) A woman who is at least thirty (30) years of age and has notgiven birth.
As added by P.L.119-1991, SEC.3.

IC 27-8-14-6
Breast cancer screening mammography; coverage
    Sec. 6. (a) Except as provided in subsection (f), an insurer mustprovide coverage for breast cancer screening mammography in anyaccident and sickness insurance policy that the insurer issues inIndiana.
    (b) Except as provided in subsection (f), the coverage that aninsurer 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 breastcancer screening mammography performed upon the insuredbefore 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 uponthe insured every year.
        (3) If the insured is at least forty (40) years of age, one (1)breast cancer screening mammography performed upon theinsured every year.
        (4) Any additional mammography views that are required forproper evaluation.
        (5) Ultrasound services, if determined medically necessary bythe physician treating the insured.
    (c) Except as provided in subsection (f), the coverage that aninsurer must provide under this section must provide reimbursementfor breast cancer screening mammography at a level at least as highas:
        (1) the limitation on payment for screening mammographyservices established in 42 CFR 405.534(b)(3) according to theMedicare Economic Index at the time the breast cancerscreening mammography is performed; or
        (2) the rate negotiated by a contract provider according to theprovisions of the insurance policy;
whichever is lower.
    (d) Except as provided in subsection (f), the coverage that aninsurer must provide under this section may not be subject to dollarlimits, deductibles, or coinsurance provisions that are less favorableto the insured than the dollar limits, deductibles, or coinsuranceprovisions applying to physical illness generally under the accidentand sickness insurance policy.
    (e) Except as provided in subsection (f), the coverage that aninsurer must provide is in addition to any benefits specificallyprovided 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 insubsections (a) through (e).
As added by P.L.119-1991, SEC.3. Amended by P.L.170-1999,SEC.3.