2021 Kentucky Revised Statutes Chapter 304 - Insurance code Subtitle 304.32 - Nonprofit Hospital, Medical-Surgical, Dental and Health Service Corporations 304.32-1593 Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Duties of insurer.
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304.32-1593
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 nonprofit hospital, medical-surgical, dental, and health service corporations
issuing contracts in this Commonwealth providing hospital, medical, or surgical
expense benefits shall make available and offer to the purchaser coverage for:
(a) The following, if medical and surgical benefits with respect to a mastectomy
are covered, 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 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 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. secs. 300gg-6 and 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. secs.
300gg-6 and 300gg-52.
Effective: July 15, 2002
History: Amended 2002 Ky. Acts ch. 181, sec. 20, effective July 15, 2002. -- Created
1998 Ky. Acts ch. 427, sec. 4, effective July 15, 1998.
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