SB474 Alabama 2013 Session

Summary

Primary Sponsor

Harri Anne Smith

Republican

Co-Sponsors

Priscilla DunnVivian Davis FiguresLinda Coleman-MadisonTammy Irons

Session

Regular Session 2013

Title

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

Summary

Alabama health benefit plans would be required to cover breast reconstruction after a mastectomy, with related procedures and protections for patients.

What This Bill Does

If enacted, the bill requires all health benefit plans executed or renewed in Alabama to include coverage for breast reconstruction after a mastectomy, including all stages of reconstruction, reconstruction of the other breast for symmetry, prostheses, and treatment of complications such as lymphedema. Coverage can have the same deductibles and coinsurance as other benefits, and written notice of the availability must be provided to policyholders at enrollment and annually. It also prohibits denying eligibility or renewal to avoid compliance and bans incentives or penalties that could reduce protections or pressure providers to deviate from the act; self-funded plans administered by employers are not covered by this act.

Who It Affects

• Individuals in Alabama who have had a mastectomy and may seek breast reconstruction will have mandatory coverage for all stages of reconstruction, symmetry procedures, prostheses, and related complications.
• Health benefit plan issuers and employers offering health plans in Alabama (including insurers and HMOs) must provide this coverage and issue related notices; self-funded plans administered by employers are exempt from these requirements.

Key Provisions

• All health benefit plans executed or renewed after the act's effective date must cover breast reconstruction after mastectomy, including all reconstruction stages and symmetry procedures.
• Coverage may be subject to the same deductible and coinsurance terms as other medical benefits; a reasonable copayment or coinsurance may apply.
• Written notice of coverage for breast reconstruction must be given to the policyholder at the start of the policy and annually thereafter.
• Plans cannot deny eligibility or renewal to avoid compliance, cannot offer incentives to patients or providers to bypass protections, and cannot restrict coverage for portions of hospital stays in a way that undermines the overall coverage.
• Self-funded or employer-administered plans that are not insured are not required to follow this act.
• The act becomes effective on the first day of the third month after it passes and is approved.

AI-generated summary using openai/gpt-5-nano on Feb 25, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance