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 Arkansas Code Title 23, Chapter 79, specifically addressing coverage for breast reconstruction surgery. The bill defines key terms related to the surgeries, including "breast reconstruction surgery," "health benefit plan," and "healthcare insurer." It requires that all modalities and techniques of breast reconstruction surgery be covered, with costs not exceeding the in-network rates of the health benefit plan. 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 eligibility to enrollees to avoid compliance with the new requirements, and it prohibits any contractual waivers of these provisions. The Insurance Commissioner is tasked with developing rules for the implementation of this subchapter.