Relating to health insurance coverage for certain post-mastectomy related issues, and including applicability provisions

This bill relates to health insurance coverage for certain post-mastectomy related issues. The bill defines “mastectomy” as the removal of all or part of a breast for a medically necessary reason as determined by a covered person’s health care professional. The bill requires a health carrier that offers individual, group, or small group contracts, policies, or plans (plans) in this state that provide for third-party payment or prepayment of health or medical expenses, and that provide coverage for mastectomies, to provide coverage for physical complications caused by a mastectomy, including lymphedema; prosthetic devices; a custom fabricated breast prothesis for each breast on which a mastectomy has been performed; one additional breast prothesis for each breast affected by a mastectomy; all stages of reconstruction of the breast on which the mastectomy has been performed; and surgery and reconstruction of the breast on which the mastectomy was not performed to produce symmetry with the other breast. The coverage cannot be subject to cost sharing that is greater than the cost sharing that a plan imposes for a mastectomy under the plan. The bill applies to the third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance which are not subject to the coverage requirements of the bill. The commissioner of insurance must adopt rules to administer the requirements of the bill. The bill applies to third-party payment provider plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2022.