Title 31A Chapter 22 Section 630

Insurance Code
Contracts in Specific Lines
Section 630
Mastectomy coverage.


31A-22-630.   Mastectomy coverage.

            (1) If an insured has coverage that provides medical and surgical benefits with respect to a mastectomy, it shall provide coverage, with consultation of the attending physician and the patient, for:

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

            (b) surgery and reconstruction of the breast on which the mastectomy was not performed to produce symmetrical appearance; and

            (c) prostheses and physical complications with regards to all stages of mastectomy, including lymphedemas.

            (2) (a) This section does not prevent an accident and health insurer from imposing cost-sharing measures for health benefits relating to this coverage, if cost-sharing measures are not greater than those imposed on any other medical condition.

            (b) For purposes of this Subsection (2), cost-sharing measures include imposing a deductible or coinsurance requirement.

            (3) Written notice of the availability of the coverage described in Subsection (1) shall be delivered to the participant:

            (a) upon enrollment; and

            (b) annually after the enrollment.

Amended by Chapter 116, 2001 General Session