Section 2016.30  Required Coverage for Reconstructive Surgery Following Mastectomies

Every policy, contract, or certificate of group or individual insurance that provides medical and surgical benefits with respect to a mastectomy shall provide, in a case of an insured who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy, coverage in a manner determined in consultation with the attending physician and the patient for:

a)         Reconstruction for the breast on which the mastectomy has been performed;

b)         Surgery and reconstruction of the other breast to produce a symmetrical appearance; and

c)         Prostheses and physical complications for all stages of mastectomy, including lymphedemas.

Such 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 coverage. Written notice of the availability of coverage under this Part shall be delivered to the insured upon enrollment and annually thereafter.