(1) Any group, blanket, or franchise accident or health insurance policy that provides coverage for mastectomies must also provide coverage for prosthetic devices and breast reconstructive surgery incident to the mastectomy. The insurer may charge an appropriate additional premium for the coverage required by this subsection. The coverage for prosthetic devices and breast reconstructive surgery shall be subject to any deductible and coinsurance conditions, and all other terms and conditions applicable to other benefits. Breast reconstructive surgery must be in a manner chosen by the treating physician under contract with the health maintenance organization, consistent with prevailing medical standards, and in consultation with the patient.
(2) As used in this section, the term “mastectomy” means the removal of all or part of the breast for medically necessary reasons as determined by a licensed physician, and the term “breast reconstructive surgery” means surgery to reestablish symmetry between the two breasts.
History.—ss. 3, 4, ch. 87-262; s. 5, ch. 88-269; ss. 66, 114, ch. 92-318; s. 7, ch. 97-48.
Structure Florida Statutes
Chapter 627 - Insurance Rates and Contracts
Part VII - Group, Blanket, and Franchise Health Insurance Policies (Ss. 627.651-627.66997)
627.651 - Group contracts and plans of self-insurance must meet group requirements.
627.6512 - Exemption of certain group health insurance policies.
627.6515 - Out-of-state groups.
627.652 - Group health insurance; definitions.
627.6525 - Short-term health insurance.
627.654 - Labor union, association, and small employer health alliance groups.
627.6551 - Teacher and student groups.
627.6561 - Preexisting conditions.
627.65612 - Limit on preexisting conditions.
627.65615 - Special enrollment periods.
627.6562 - Dependent coverage.
627.65626 - Insurance rebates for healthy lifestyles.
627.6563 - Full-time employment defined.
627.657 - Provisions of group health insurance policies.
627.6571 - Guaranteed renewability of coverage.
627.6572 - Pharmacy benefit manager contracts.
627.65735 - Nondiscrimination of coverage for surgical procedures.
627.65736 - Coverage for organ transplants.
627.65745 - Diabetes treatment services.
627.6575 - Coverage for newborn children.
627.65755 - Dental procedures; anesthesia and hospitalization coverage.
627.6579 - Coverage for child health supervision services.
627.658 - Use of dividends, refunds, rate reductions, commissions, service fees; premium rates.
627.659 - Blanket health insurance; eligible groups.
627.660 - Conditions and provisions of blanket health insurance policies.
627.661 - School accident insurance claims; policy service.
627.6612 - Coverage for surgical procedures and devices incident to mastectomy.
627.66121 - Coverage for length of stay and outpatient postsurgical care.
627.66122 - Requirements with respect to breast cancer and routine followup care.
627.6613 - Coverage for mammograms.
627.6615 - Children with disabilities; continuation of coverage under group policy.
627.6616 - Coverage for ambulatory surgical center service.
627.6617 - Coverage for home health care services.
627.6618 - Payment of acupuncture benefits to certified acupuncturists.
627.662 - Other provisions applicable.
627.6621 - Advanced practice registered nurse services.
627.663 - Franchise health insurance.
627.664 - Assignment of incidents of ownership in group, blanket, or franchise health policies.
627.6645 - Notification of cancellation, expiration, nonrenewal, or change in rates.
627.6646 - Cancellation or nonrenewal prohibited.
627.6648 - Shared savings incentive program.
627.667 - Extension of benefits.
627.6675 - Conversion on termination of eligibility.
627.668 - Optional coverage for mental and nervous disorders required; exception.
627.6686 - Coverage for individuals with autism spectrum disorder required; exception.
627.669 - Optional coverage required for substance abuse impaired persons; exception.
627.6691 - Coverage for osteoporosis screening, diagnosis, treatment, and management.
627.66911 - Required coverage for cleft lip and cleft palate.
627.6692 - Florida Health Insurance Coverage Continuation Act.
627.6699 - Employee Health Care Access Act.
627.66996 - Restrictions on use of state and federal funds for state exchanges.