The proposed bill mandates coverage for breast reconstruction surgeries under health benefit plans in Arkansas, effective January 1, 2026. It establishes a new subchapter in the Arkansas Code, specifically detailing definitions related to breast reconstruction surgery, including various modalities and techniques. The bill requires that health benefit plans cover all types of breast reconstruction surgeries deemed necessary by healthcare professionals, ensuring that coverage is subject to the same deductibles and copayments as in-network services. Additionally, if an enrollee must use an out-of-network provider due to network inadequacies, their financial responsibility will remain at the in-network rate.

Furthermore, the bill stipulates that prior authorization is required for breast reconstruction surgeries, and if a healthcare insurer lacks a participating provider, they must approve a single case agreement at the specified reimbursement rate. The reimbursement for out-of-network providers is set at either the billed charges or the 80th percentile of charges for similar services in the area. The bill also includes provisions to prevent insurers from denying coverage based on the requirements of this subchapter and prohibits any contractual waivers of its provisions. The Insurance Commissioner is tasked with developing rules for the implementation of this subchapter.