376.1209. Mastectomy--mandatory insurance coverage for prosthetic devices and reconstructive surgery--no time limit to be imposed.
Mastectomy--mandatory insurance coverage for prosthetic devices andreconstructive surgery--no time limit to be imposed.
376.1209. 1. Each entity offering individual and group healthinsurance policies providing coverage on an expense-incurred basis,individual and group service or indemnity type contracts issued by anonprofit corporation, individual and group service contracts issued by ahealth maintenance organization, all self-insured group arrangements to theextent not preempted by federal law, and all managed health care deliveryentities of any type or description, that provide coverage for the surgicalprocedure known as a mastectomy, and which are delivered, issued fordelivery, continued or renewed in this state on or after January 1, 1998,shall provide coverage for prosthetic devices or reconstructive surgerynecessary to restore symmetry as recommended by the oncologist or primarycare physician for the patient incident to the mastectomy. Coverage forprosthetic devices and reconstructive surgery shall be subject to the samedeductible and coinsurance conditions applied to the mastectomy and allother terms and conditions applicable to other benefits with the exceptionthat no time limit shall be imposed on an individual for the receipt ofprosthetic devices or reconstructive surgery and if such individual changeshis or her insurer, then the new policy subject to the federal Women'sHealth and Cancer Rights Act (Sections 901-903 of P.L. 105-277), asamended, shall provide coverage consistent with the federal Women's Healthand Cancer Rights Act (Sections 901-903 of P.L. 105-277), as amended, andany regulations promulgated pursuant to such act.
2. As used in this section, the term "mastectomy" means the removalof all or part of the breast for medically necessary reasons, as determinedby a physician licensed pursuant to chapter 334, RSMo.
3. The provisions of this section shall not apply to a supplementalinsurance policy, including a life care contract, accident-only policy,specified disease policy, hospital policy providing a fixed daily benefitonly, Medicare supplement policy or long-term care policy.
(L. 1997 H.B. 129, A.L. 2001 H.B. 762)