Bill > S555

This bill, known as the "Women's Health and Cancer Recovery Act," mandates that insurers and health maintenance organizations (HMOs) provide specific coverage for women's health and cancer recovery. It requires coverage for medically appropriate hospital stays following lymph node dissection, lumpectomy, or mastectomy for breast cancer, subject to deductibles and coinsurance set by the Division of Insurance. The bill also ensures coverage for a second medical opinion from a specialist for cancer diagnoses, recurrences, or treatment recommendations, regardless of whether the specialist is within the insurer's network, with specific provisions for cost-sharing. Furthermore, it mandates comprehensive coverage for breast reconstruction surgery after a mastectomy, including all stages of reconstruction on the affected breast, surgery on the other breast for symmetry, and prostheses and complications like lymphedema. Coverage for lymphedema treatment, including equipment, therapy, and education, is also required. Insurers must notify policyholders of this coverage and are prohibited from denying eligibility, varying policy terms, incentivizing less than minimum protections, penalizing practitioners for providing care according to the act, or offering incentives to practitioners to provide care inconsistently with the act. This act takes effect on January 1st of the following year and applies to policies issued or renewed thereafter, with certain exclusions such as accidental death, short-term travel, wage replacement, Medicare supplemental policies, and workers' compensation.