Under existing federal law, a group health plan and a health insurance issuer providing health insurance coverage in connection with a group health plan that provides medical and surgical benefits for a mastectomy is required to provide, in a case of a participant or beneficiary who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with the mastectomy, coverage for all stages of reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and physical complications of mastectomy, including lymphedemas in a manner determined in consultation with the attending physician and the patient. The coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the plan or coverage. Written notice of the availability of the coverage is required to be delivered to the participant upon enrollment and annually thereafter.
This bill would require all health benefit plans executed or renewed in this state to include coverage for breast reconstruction surgery after a mastectomy.
Whatley to table Smitherman motion to rerefer adopted Roll Call 579
Smitherman motion to rerefer
Read for the first time and referred to the Senate committee on Banking and Insurance
Source: Alabama Legislature