HB768 Alabama 2012 Session

Summary

Primary Sponsor

Daniel H. Boman

Republican

Session

Regular Session 2012

Title

Health benefit plans, breast cancer reconstruction surgery, coverage required on individual health benefit plans after a mastectomy, Secs. 10A-20-6.16, 27-21A-23 am'd

Summary

HB768 would require Alabama's individual health plans to cover breast reconstruction after mastectomy.

What This Bill Does

The bill requires all individual health benefit plans issued or renewed in Alabama to cover breast reconstruction after a mastectomy, including all stages of reconstruction on the affected breast, reconstruction of the other breast for symmetry, prostheses, and treatment of related complications like lymphedema, with decisions made in consultation with the doctor and patient. Coverage may use deductibles and coinsurance like other benefits. Written notice about this coverage must be provided to policyholders at policy start and annually thereafter. It also prohibites denial of eligibility to enroll or renew to avoid compliance, bans incentives to reduce protections, and prohibits penalties on providers for following the act; self-funded plans may be exempt from these requirements.

Who It Affects

• Individuals in Alabama who have or will obtain an individual health benefit plan and have undergone or will undergo mastectomy, who would receive coverage for breast reconstruction and related services.
• Insurers and other entities that issue or administer individual health benefit plans in Alabama (including HMOs/health plans), who would be required to offer the specified coverage and follow the act’s rules.

Key Provisions

• All individual health benefit plans in Alabama must offer coverage for breast reconstruction after mastectomy, including all stages of reconstruction on the affected breast, reconstruction of the other breast for symmetry, and prostheses and related complications, with care planned in consultation with the attending physician and patient.
• Coverage may include the same deductibles and coinsurance as other benefits under the plan.
• Written notice of the availability of this coverage must be provided to the policyholder at policy inception and annually thereafter.
• Insurers and participating entities may not deny eligibility to enroll or renew to avoid compliance, may not provide incentives to accept less than the protections, and may not reduce or penalize providers for following this act; coverage must not be restricted for any portion of a hospital stay in a way that conflicts with the overall coverage.
• The act defines what a health benefit plan is and states that plans located outside Alabama are subject to the act if they process claims for Alabama residents or services; it also extends to various types of health plans and providers.
• The bill amends Sections 10A-20-6.16 and 27-21A-23 to require compliance with these breast reconstruction coverage rules and to align with other health plan standards (including taxes, discrimination rules, timely payment, and additional mandated coverages). Self-funded plans administered by the same corporation are exempt from some provisions.
• Effective date: the act becomes effective on the first day of the third month after passage and approval by the Governor (or as otherwise stated by law).

AI-generated summary using openai/gpt-5-nano on Feb 24, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance