2014 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 17A - Health Benefit Plans 17A.17A-134 Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Requirements for health benefit plan.
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304.17A-134 Coverage for medical and surgical benefits with respect to
mastectomy, diagnosis and treatment of endometrioses and
endometritis, and bone density testing -- Requirements for health benefit
plan.
(1)
(2)
(3)
(4)
A health benefit plan shall make available and offer to the purchaser coverage
for:
(a) The following, if a health benefit plan 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
the 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 health
benefit plan 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 health benefit plan under this section shall offer medical and surgical
benefits with respect to a mastectomy that requires the procedure be
performed on an outpatient basis.
A health benefit plan 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.
A health benefit plan 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. 2, effective July 15, 2002. -Created 1998 Ky. Acts ch. 427, sec. 2, effective July 15, 1998.
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