Indiana Code
Chapter 5. Accident and Sickness Insurance─policy Provisions
27-8-5-26. Post-Mastectomy Coverage

Sec. 26. (a) As used in this section, "mastectomy" means the removal of all or part of the breast for reasons that are determined by a licensed physician to be medically necessary.
(b) A policy of accident and sickness insurance that provides coverage for a mastectomy may not be issued, amended, delivered, or renewed in Indiana unless the policy provides coverage as required under 29 U.S.C. 1185b, including coverage for:
(1) prosthetic devices; and
(2) reconstructive surgery incident to a mastectomy including:
(A) all stages of reconstruction of the breast on which the mastectomy has been performed; and
(B) surgery and reconstruction of the other breast to produce symmetry;
in the manner determined by the attending physician and the patient to be appropriate.
(c) In addition to the coverage required by 29 U.S.C. 1185b, a policy of accident and sickness insurance that provides coverage for a mastectomy must provide coverage for:
(1) custom fabricated breast prostheses; and
(2) one (1) additional breast prosthesis per breast affected by the mastectomy.
(d) Coverage required under this section is subject to:
(1) the deductible and coinsurance provisions applicable to a mastectomy; and
(2) all other terms and conditions applicable to other benefits.
(e) An insurer that issues a policy of accident and sickness insurance shall provide to an insured, at the time the policy is issued and annually thereafter, written notice of the coverage required under this section. Notice that is sent by the insurer that meets the requirements set forth in 29 U.S.C. 1185b constitutes compliance with this subsection.
(f) The coverage required under this section applies to a policy of accident and sickness insurance that provides coverage for a mastectomy, regardless of whether an individual who:
(1) underwent a mastectomy; and
(2) is covered under the policy;
was covered under the policy at the time of the mastectomy.
(g) Except as provided in subsection (c), this section does not require an insurer to provide coverage related to post mastectomy care that exceeds the coverage required for post mastectomy care under federal law.
As added by P.L.150-1997, SEC.3. Amended by P.L.96-2002, SEC.2; P.L.204-2003, SEC.1; P.L.67-2020, SEC.2.

Structure Indiana Code

Indiana Code

Title 27. Insurance

Article 8. Life, Accident, and Health

Chapter 5. Accident and Sickness Insurance─policy Provisions

27-8-5-0.1. Application of Certain Amendments to Chapter

27-8-5-1. Policy of Accident and Sickness Insurance; Filing; Review; Conformity With Federal Act

27-8-5-1.5. Filing, Review, Approval, and Disapproval Process

27-8-5-2. Requirements for Issuance and Delivery of Policy

27-8-5-2.5. Coverage Under Individual, and Certain Association Group, Policies of Accident and Sickness Insurance; Waivers

27-8-5-2.6. Repealed

27-8-5-2.7. Individual Policy of Accident and Sickness Insurance; Waiver of Coverage

27-8-5-3. Required Provisions; Statutory Option Provisions; Inapplicable or Inconsistent Provisions; Order of Provisions; Third Party Ownership; Requirements of Other Jurisdictions; Filing Procedure

27-8-5-4. Effect of Other Policy Provisions or Policy Conflicting With Chapter

27-8-5-5. Application; Attaching Copy to Policy; Furnishing Copy to Insured; Alterations; Effect of False Statements

27-8-5-6. Defenses of Insurer; Acts Not Constituting Waiver

27-8-5-7. Acceptance of Premium for Period Beyond Termination Date; Effect; Misstatement of Age

27-8-5-8. Exemption of Accident and Sickness Coverage Incidental to Designated Other Forms of Insurance

27-8-5-9. Exemption of Certain Individual Policies

27-8-5-10. Repealed

27-8-5-11. Franchise Plan; Accident and Sickness Insurance; Definitions, Limitations, Requirements, and Standards

27-8-5-12. Supplementary Character of Chapter

27-8-5-13. Repeal of 1935 Act

27-8-5-14. Exception of Fraternal Benefit Associations

27-8-5-15. Blanket Accident and Sickness Insurance; Qualification of Groups; Policy Provisions; Payment of Benefits

27-8-5-15.5. Inpatient Services for Treatment of Mental Illness or Substance Abuse

27-8-5-15.6. Treatment Limitations or Financial Requirements on Coverage of Services for Mental Illness

27-8-5-15.7. Exemption of Policies or Contracts From Laws Resulting in Certain Annual Premium Increases

27-8-5-15.8. "Treatment of a Mental Illness or Substance Abuse"; "Act"; "Nonqualitative Treatment Limitations"; Insurer Reporting and Analysis Requirements

27-8-5-16. Policy of Group Accident and Sickness Insurance; Requirements

27-8-5-16.3. "Small Employer"; Implementation of Program for Joint Purchase of Health Insurance; Rules

27-8-5-16.5. Conditions for Issuance of Certificate to Resident of Indiana Under Group Policy Delivered or Issued in Another State

27-8-5-17. Exceptions; Discretionary Groups; Group Accident and Sickness Insurance

27-8-5-18. Extension to Family Members or Dependents; Premiums; Exclusions; Group Accident and Sickness Insurance

27-8-5-19. Contents; Group Accident and Sickness Insurance

27-8-5-19.2. Repealed

27-8-5-19.3. Association and Discretionary Group Policies of Accident and Sickness Insurance; Waiver of Coverage

27-8-5-20. Notice of Right to Return Policy

27-8-5-21. Adopted Children

27-8-5-22. Refund of Unused Premiums

27-8-5-23. Statute or Rule Mandating Particular Types of Health Care Coverage; Applications to Insurer

27-8-5-24. Insured Issued New Policy Within Year After Cancellation or Nonrenewal; Mandatory Coverage

27-8-5-25. Maternity Benefits; Replacement of Discontinued Policy; Prohibition on Preexisting Condition Limitation or Exclusion of Coverage

27-8-5-26. Post-Mastectomy Coverage

27-8-5-27. Dental Care Provisions Required

27-8-5-28. Coverage of Child to 26 Years of Age

27-8-5-29. Health Plans Offered Through Health Benefit Exchange

27-8-5-30. Step Therapy Protocol

27-8-5-31. Repealed

27-8-5-31.5. Insurer Removing Prescription Drug From Formulary or Changing Cost Sharing; Written Notice and Appeal Process