The proposed bill mandates coverage for breast reconstruction surgeries in Arkansas, requiring health benefit plans to provide comprehensive coverage for all modalities, types, and techniques of breast reconstruction surgery starting January 1, 2026. It stipulates that coverage must be consistent with prevailing medical standards and determined in consultation with the patient. Additionally, the bill establishes that prior authorization is required for these surgeries, and it ensures that coverage does not diminish or limit existing benefits under health plans.

Furthermore, the bill sets a minimum reimbursement rate for out-of-network providers performing breast reconstruction surgeries when no participating provider is available. The reimbursement will be based on either the healthcare professional's billed charges or the 80th percentile of charges for similar services in the same geographical area, as reported by a nonprofit benchmarking database. The bill also prohibits any contractual waivers of its provisions and allows the Insurance Commissioner to develop rules for its implementation.