The proposed bill would update current statutes by mandating that health insurance contracts covering mastectomy surgical services must also include coverage for autologous breast reconstruction procedures and related medically necessary services, ensuring that such coverage is not less favorable than that for other breast reconstruction services. It would also require compliance with network adequacy standards, accepted clinical practice guidelines, and access to out-of-network providers without unreasonable delay, while specifying that out-of-network providers cannot charge more than the reimbursement amount set by the health benefit plan. Additionally, the bill would clarify definitions related to inherited metabolic disorders and expand the list of procedures considered part of autologous breast reconstruction. It would remove outdated language and ensure comprehensive coverage for these procedures, including revisions and related services. The bill emphasizes that health care services organizations must provide adequate notice before canceling or refusing to renew coverage, while maintaining protections against discrimination based on age, sex, or health status. Overall, these updates aim to enhance the quality and accessibility of health insurance coverage for individuals undergoing mastectomy and related procedures.

Statutes affected:
Introduced Version: 20-826, 20-1057, 20-1342, 20-1383, 20-1402, 20-1404, 20-2341, 8-105, 8-108, 20-841.05, 20-162, 36-694, 104-191, 20-2309, 20-1379, 20-1380, 20-1057.02, 20-1345, 20-1368, 20-461, 20-1376, 20-1342.01, 20-1376.01, 20-1376.02, 20-1376.03, 20-1376.04, 20-1137, 20-2301, 20-485