Bill

Bill > HB1373


IN HB1373

IN HB1373
Breast reconstruction coverage.


summary

Introduced
01/08/2026
In Committee
01/08/2026
Crossed Over
Passed
Dead

Introduced Session

2026 Regular Session

Bill Summary

Breast reconstruction coverage. Repeals provisions requiring a state employee health plan, policy of accident and sickness insurance, and health maintenance organization contract to provide certain post-mastectomy coverage. Requires a state employee health plan, policy of accident and sickness insurance, and health maintenance organization contract to: (1) provide coverage for breast reconstruction surgery and all modalities, types, and techniques of a health care service provided for the breast reconstruction surgery; and (2) provide access to an adequate breast reconstruction surgeon network. Prohibits a utilization review entity from denying a claim for breast reconstruction surgery for which prior authorization was granted unless the utilization review entity provides a formal declaration of compelling evidence of health care provider fraud in the prior authorization or claim submission process.

AI Summary

This bill, effective January 1, 2027, requires state employee health plans, accident and sickness insurance policies, and health maintenance organization contracts to provide comprehensive coverage for breast reconstruction surgery, including all stages, techniques, and modalities, and to ensure access to an adequate network of breast reconstruction surgeons. It also prohibits utilization review entities, which are organizations that review the appropriateness of medical services, from denying a claim for breast reconstruction surgery that was previously authorized unless they can provide formal proof of fraud by the healthcare provider. This bill repeals older provisions that had less comprehensive requirements for post-mastectomy coverage and establishes new, broader mandates for breast reconstruction coverage.

Committee Categories

Business and Industry

Sponsors (2)

Last Action

First reading: referred to Committee on Insurance (on 01/08/2026)

bill text


bill summary

Loading...

bill summary

Loading...
Loading...