Plain English Breakdown
The official source does not provide specific details on when the changes will take effect or how many people are currently affected by the old post-mastectomy coverage requirements.
Breast Reconstruction Coverage Act
This bill amends Indiana's insurance laws to require certain health plans and policies to cover breast reconstruction surgery and related services, while also setting rules for how claims are reviewed.
What This Bill Does
- Repeals old requirements that state employee health plans must provide post-mastectomy coverage.
- Requires new coverage for breast reconstruction surgery and all types of care needed for the surgery.
- Ensures access to an adequate network of breast reconstruction surgeons.
- Prohibits utilization review entities from denying claims for breast reconstruction surgery unless there is proof of fraud.
Who It Names or Affects
- People with state employee health plans, accident and sickness insurance policies, or health maintenance organization contracts.
- Health care providers who perform breast reconstruction surgeries.
- Insurance companies that provide these types of coverage.
Terms To Know
- Utilization review entity
- A company that checks if medical treatments are necessary and covered by insurance policies.
- Prior authorization
- Permission from an insurance company to get a specific treatment or service before it happens.
Limits and Unknowns
- The bill does not specify when the changes will take effect.
- It is unclear how many people are currently affected by the old post-mastectomy coverage requirements.