Current with changes from the 2024 Legislative Session
Section 15-815 - Coverage for reconstructive breast surgery(a)(1) In this section the following words have the meanings indicated.(2) "Mastectomy" means the surgical removal of all or part of a breast.(3)(i) "Reconstructive breast surgery" means surgery performed as a result of a mastectomy to reestablish symmetry between the two breasts.(ii) "Reconstructive breast surgery" includes augmentation mammoplasty, reduction mammoplasty, and mastopexy.(b) This section applies to contracts issued by:(1) insurers and nonprofit health service plans that provide medical and surgical benefits to individuals or groups on an expense-incurred basis under health insurance contracts that are issued or delivered in the State; and(2) health maintenance organizations that provide medical and surgical benefits to individuals or groups under contracts that are issued or delivered in the State.(c) A contract subject to this section shall provide coverage for: (1) reconstructive breast surgery, including coverage for all stages of reconstructive breast surgery performed on a nondiseased breast to establish symmetry with the diseased breast when reconstructive breast surgery is performed on the diseased breast; and(2) physical complications of all stages of mastectomy, including lymphedemas, in a manner determined in consultation with the attending physician and the patient.