§ 58‑67‑79. Coverage for reconstructive breast surgery following mastectomy.
(a) Every health careplan written by a health maintenance organization that is subject to thisArticle and that provides coverage for mastectomy shall provide coverage forreconstructive breast surgery following a mastectomy. The coverage shallinclude coverage for all stages and revisions of reconstructive breast surgeryperformed on a nondiseased breast to establish symmetry if reconstructivesurgery on a diseased breast is performed, as well as coverage for prosthesesand physical complications in all stages of mastectomy, including lymphademas.The same deductibles, coinsurance, and other limitations as apply to similarservices covered under the policy, contract, or plan shall apply to coveragefor reconstructive breast surgery. Reconstruction of the nipple/areolar complexfollowing a mastectomy is covered without regard to the lapse of time betweenthe mastectomy and the reconstruction, subject to the approval of the treatingphysician.
(b) As used in thissection, the following terms have the meanings indicated:
(1) "Mastectomy"means the surgical removal of all or part of a breast as a result of breastcancer or breast disease.
(2) "Reconstructivebreast surgery" means surgery performed as a result of a mastectomy toreestablish symmetry between the two breasts, and includes reconstruction ofthe mastectomy site, creation of a new breast mound, and creation of a newnipple/areolar complex. "Reconstructive breast surgery" also includesaugmentation mammoplasty, reduction mammoplasty, and mastopexy of thenondiseased breast.
(c) A policy, contract,or plan subject to this section shall not:
(1) Deny coveragedescribed in subsection (a) of this section on the basis that the coverage isfor cosmetic surgery;
(2) Deny to a womaneligibility or continued eligibility to enroll or to renew coverage under theterms of the contract, policy, or plan, solely for the purpose of avoiding therequirements of this section;
(3) Provide monetarypayments or rebates to a woman to encourage her to accept less than the minimumprotections available under this section;
(4) Penalize orotherwise reduce or limit the reimbursement of an attending provider becausethe provider provided care to an individual participant or beneficiary inaccordance with this section; or
(5) Provide incentives,monetary or otherwise, to an attending provider to induce the provider toprovide care to an individual participant or beneficiary in a mannerinconsistent with this section.
(d) Written notice ofthe availability of the coverage provided by this section shall be delivered toevery subscriber under the plan upon enrollment and annually thereafter. Thenotice required by this subsection may be included as a part of any yearlyinformational packet sent to the subscriber. (1997‑312, s. 3; 1999‑351, s. 3.3; 2001‑334,s. 13.3.)
§ 58‑67‑79. Coverage for reconstructive breast surgery following mastectomy.
(a) Every health careplan written by a health maintenance organization that is subject to thisArticle and that provides coverage for mastectomy shall provide coverage forreconstructive breast surgery following a mastectomy. The coverage shallinclude coverage for all stages and revisions of reconstructive breast surgeryperformed on a nondiseased breast to establish symmetry if reconstructivesurgery on a diseased breast is performed, as well as coverage for prosthesesand physical complications in all stages of mastectomy, including lymphademas.The same deductibles, coinsurance, and other limitations as apply to similarservices covered under the policy, contract, or plan shall apply to coveragefor reconstructive breast surgery. Reconstruction of the nipple/areolar complexfollowing a mastectomy is covered without regard to the lapse of time betweenthe mastectomy and the reconstruction, subject to the approval of the treatingphysician.
(b) As used in thissection, the following terms have the meanings indicated:
(1) "Mastectomy"means the surgical removal of all or part of a breast as a result of breastcancer or breast disease.
(2) "Reconstructivebreast surgery" means surgery performed as a result of a mastectomy toreestablish symmetry between the two breasts, and includes reconstruction ofthe mastectomy site, creation of a new breast mound, and creation of a newnipple/areolar complex. "Reconstructive breast surgery" also includesaugmentation mammoplasty, reduction mammoplasty, and mastopexy of thenondiseased breast.
(c) A policy, contract,or plan subject to this section shall not:
(1) Deny coveragedescribed in subsection (a) of this section on the basis that the coverage isfor cosmetic surgery;
(2) Deny to a womaneligibility or continued eligibility to enroll or to renew coverage under theterms of the contract, policy, or plan, solely for the purpose of avoiding therequirements of this section;
(3) Provide monetarypayments or rebates to a woman to encourage her to accept less than the minimumprotections available under this section;
(4) Penalize orotherwise reduce or limit the reimbursement of an attending provider becausethe provider provided care to an individual participant or beneficiary inaccordance with this section; or
(5) Provide incentives,monetary or otherwise, to an attending provider to induce the provider toprovide care to an individual participant or beneficiary in a mannerinconsistent with this section.
(d) Written notice ofthe availability of the coverage provided by this section shall be delivered toevery subscriber under the plan upon enrollment and annually thereafter. Thenotice required by this subsection may be included as a part of any yearlyinformational packet sent to the subscriber. (1997‑312, s. 3; 1999‑351, s. 3.3; 2001‑334,s. 13.3.)
§ 58‑67‑79. Coverage for reconstructive breast surgery following mastectomy.
(a) Every health careplan written by a health maintenance organization that is subject to thisArticle and that provides coverage for mastectomy shall provide coverage forreconstructive breast surgery following a mastectomy. The coverage shallinclude coverage for all stages and revisions of reconstructive breast surgeryperformed on a nondiseased breast to establish symmetry if reconstructivesurgery on a diseased breast is performed, as well as coverage for prosthesesand physical complications in all stages of mastectomy, including lymphademas.The same deductibles, coinsurance, and other limitations as apply to similarservices covered under the policy, contract, or plan shall apply to coveragefor reconstructive breast surgery. Reconstruction of the nipple/areolar complexfollowing a mastectomy is covered without regard to the lapse of time betweenthe mastectomy and the reconstruction, subject to the approval of the treatingphysician.
(b) As used in thissection, the following terms have the meanings indicated:
(1) "Mastectomy"means the surgical removal of all or part of a breast as a result of breastcancer or breast disease.
(2) "Reconstructivebreast surgery" means surgery performed as a result of a mastectomy toreestablish symmetry between the two breasts, and includes reconstruction ofthe mastectomy site, creation of a new breast mound, and creation of a newnipple/areolar complex. "Reconstructive breast surgery" also includesaugmentation mammoplasty, reduction mammoplasty, and mastopexy of thenondiseased breast.
(c) A policy, contract,or plan subject to this section shall not:
(1) Deny coveragedescribed in subsection (a) of this section on the basis that the coverage isfor cosmetic surgery;
(2) Deny to a womaneligibility or continued eligibility to enroll or to renew coverage under theterms of the contract, policy, or plan, solely for the purpose of avoiding therequirements of this section;
(3) Provide monetarypayments or rebates to a woman to encourage her to accept less than the minimumprotections available under this section;
(4) Penalize orotherwise reduce or limit the reimbursement of an attending provider becausethe provider provided care to an individual participant or beneficiary inaccordance with this section; or
(5) Provide incentives,monetary or otherwise, to an attending provider to induce the provider toprovide care to an individual participant or beneficiary in a mannerinconsistent with this section.
(d) Written notice ofthe availability of the coverage provided by this section shall be delivered toevery subscriber under the plan upon enrollment and annually thereafter. Thenotice required by this subsection may be included as a part of any yearlyinformational packet sent to the subscriber. (1997‑312, s. 3; 1999‑351, s. 3.3; 2001‑334,s. 13.3.)
