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 types of procedures. The bill requires that health benefit plans cover all stages of breast reconstruction surgery as determined by healthcare professionals, ensuring that coverage is consistent with prevailing medical standards. Additionally, it stipulates that any costs associated with this coverage should not exceed the in-network rates of the health benefit plan.

Furthermore, the bill introduces a requirement for prior authorization for breast reconstruction surgeries and outlines reimbursement rates for out-of-network providers when necessary. If a healthcare insurer lacks a participating provider for the required surgery, they must approve a single case agreement at specified rates. The bill also includes provisions to protect enrollees from being denied coverage based on the requirements of this subchapter and prohibits any contractual waivers that would undermine these protections. The Insurance Commissioner is tasked with developing rules for the implementation of this subchapter, ensuring compliance and proper administration.