40-2,166. Coverage of reconstructive breast surgery. - Kansas Statutes

40-2,166

Chapter 40.--INSURANCE Article 2.--GENERAL PROVISIONS

      40-2,166.   Coverage of reconstructive breastsurgery.(a) Any individual or group health insurance policy,medical service plan, contract, hospital service corporation contract, hospitaland medical service corporation contract, fraternal benefit society or healthmaintenance organization which provides coverage for accident and healthservices and which is delivered, issued for delivery, amended or renewed on orafter July 1, 1999, and which provides medical and surgical benefits withrespect to a mastectomy shall provide, in a case of a participant orbeneficiary who is receiving benefits in connection with a mastectomy and whoelects breast reconstruction in connection with such mastectomy, coverage for:

      (1)   Reconstruction of the breast on which the mastectomy has been performed;

      (2)   surgery and reconstruction of the other breast to produce a symmetricalappearance; and

      (3)   prostheses and physical complications in all stages of mastectomy,includinglymphedemas.

      Such coverage shall be provided in a manner determined in consultation with theattending physician and the patient. Such coverage may be subject to annualdeductibles and coinsurance provisions as may be deemed appropriate and as areconsistent with those established for other benefits under the plan orcoverage.

      (b)   Each individual or group health insurance policy, medical service plan,contract, hospital service corporation contract, hospital and medical servicecorporation contract, fraternal benefit society or health maintenanceorganization which provides coverage for accident and health services whichprovides medical and surgical benefits with respect to a mastectomy shallprovide written notice, as currently required, to all enrollees, insureds orsubscribers regarding the coverage required by this section.

      (c)   No individual or group health insurance policy, medical service plan,contract, hospital service corporation contract, hospital and medical servicecorporation contract, fraternal benefit society or health maintenanceorganization which provides coverage for accident and health services whichprovides medical and surgical benefits with respect to a mastectomy shall:

      (1)   Deny to a patient eligibility, or continued eligibility, to enroll or torenew coverage under the terms of the plan, solely for the purpose of avoidingthe requirements of this section; and

      (2)   penalize or otherwise reduce or limit the reimbursement of an attendingprovider, or provide incentives (monetary or otherwise) to an attendingprovider, to induce such provider to provide care to an individual participantor beneficiary in a manner inconsistent with this section.

      (d)   The provisions of this section shall not apply to any policy orcertificate which provides coverage for any specified disease, specifiedaccident or accident only coverage, credit, dental, disability income, hospitalindemnity,long-term care insurance as defined by K.S.A. 40-2227 and amendments thereto,vision care or any other limited supplemental benefit nor to any medicaresupplement policy of insurance as defined by the commissioner of insurance byrule and regulation, any coverage issued as a supplement to liabilityinsurance, workers' compensation or similar insurance, automobilemedical-payment insurance or any insurance under which benefits are payablewith or without regard to fault, whether written on a group, blanket orindividual basis.

      History:   L. 1999, ch. 162, § 2; July 1.