2011 Kentucky Revised Statutes Subtitle 17. Health Insurance Contracts 304.17.3163 Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Duties of insurer.
KY Rev Stat § 304.17.3163 (1996 through Reg Sess) What's This?
304.17-3163 Coverage for medical and surgical benefits with respect to
mastectomy, diagnosis and treatment of endometrioses and endometritis, and
bone density testing -- Duties of insurer.
(1)
(2)
(3)
(4)
All insurers issuing individual health insurance policies in this Commonwealth
providing coverage on an expense-incurred basis shall make available and offer to
the purchaser coverage for:
(a) The following, if an insurer provides medical and surgical benefits with
respect to mastectomy, in a manner determined in consultation with the
attending physician and the covered person, and subject to annual deductibles
and coinsurance provisions as may be deemed appropriate and as are
consistent with those established for other benefits under the coverage:
1.
All stages of breast reconstruction surgery of the breast on which a
mastectomy has been performed;
2.
Surgery and reconstruction of the other breast to produce a symmetrical
appearance; and
3.
Prostheses and physical complications of all stages of mastectomy,
including lymphedemas;
(b) Diagnosis and treatment of endometriosis and endometritis if the insurer also
covers hysterectomies; and
(c) Bone density testing for women age thirty-five (35) years and older, as
indicated by the health-care provider, in accordance with standard medical
practice, to obtain baseline data for the purpose of early detection of
osteoporosis.
No insurer under this section shall offer medical and surgical benefits with respect
to a mastectomy that requires the procedure to be performed on an outpatient basis.
An insurer shall provide written notice to a covered person of the availability of
medical and surgical benefits with respect to a mastectomy upon enrollment and
annually thereafter.
An insurer shall not:
(a) Deny eligibility, or continued eligibility, to an individual to enroll or to renew
coverage under the terms of the plan, solely for the purpose of avoiding the
requirements of 42 U.S.C. sec. 300gg-52; and
(b) Penalize or otherwise reduce or limit the reimbursement of an attending
provider, or provide incentives to an attending provider, to induce the provider
to provide care to an individual in a manner inconsistent with 42 U.S.C. sec.
300gg-52.
Effective: July 15, 2002
History: Amended 2002 Ky. Acts ch. 181, sec. 1, effective July 15, 2002. -- Created
1998 Ky. Acts ch. 427, sec. 1, effective July 15, 1998.
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