Sec. 16.5. (a) As used in this section, "covered individual" means an individual who is entitled to coverage under a state employee health plan.
(b) As used in this section, "mastectomy" means the removal of all or part of a breast for reasons that are determined by a licensed physician to be medically necessary.
(c) A state employee health plan that provides coverage for a mastectomy must provide 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 covered individual to be appropriate.
(d) In addition to the coverage required by 29 U.S.C. 1185b, a state employee health plan 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.
(e) 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.
(f) A state employee health plan must provide to a covered individual, when the individual's coverage under the state employee health plan begins and annually thereafter, written notice of the coverage required under this section. Notice that is sent by the state employee health plan that meets the requirements set forth in 29 U.S.C. 1185b constitutes compliance with this subsection.
(g) The coverage required under this section applies to a state employee health plan that provides coverage for a mastectomy, regardless of whether an individual who:
(1) underwent a mastectomy; and
(2) is covered under the state employee health plan;
was covered under the state employee health plan at the time of the mastectomy.
(h) Except as provided in subsection (d), this section does not require a state employee health plan to provide coverage related to postmastectomy care that exceeds the coverage required for postmastectomy care under federal law.
As added by P.L.67-2020, SEC.1.
Structure Indiana Code
Title 5. State and Local Administration
Article 10. Public Employee Benefits
Chapter 8. Group Insurance for Public Employees
5-10-8-0.1. Application of Certain Amendments to Chapter
5-10-8-0.3. Use of Certain Accrued Benefits by State Employees
5-10-8-0.4. Legalization of Certain Payments of Deductible Portion of Group Health Insurance
5-10-8-2.2. Public Safety Employees; Surviving Spouses; Dependents
5-10-8-2.7. Insurance of Rostered Volunteers
5-10-8-4. Discrimination as to Form of Insurance Between Certain Employees; Exception
5-10-8-5. Establishment of Common and Unified Plan of Group Insurance
5-10-8-6.5. General Assembly Members and Former Members
5-10-8-6.7. Election of State Employee Health Care Program by School Corporation
5-10-8-7.1. Coverage for Autism Spectrum Disorder
5-10-8-7.3. Early Intervention Services for First Steps Children
5-10-8-7.5. Prostate Specific Antigen Test
5-10-8-7.7. Surgical Treatment for Morbid Obesity
5-10-8-7.8. Colorectal Cancer Testing Coverage; Exception for High Deductible Health Plans
5-10-8-8. Retired Employees; Ability of Employer to Pay Premiums; Eligibility
5-10-8-8.1. Retired Legislators
5-10-8-8.2. Former Legislators
5-10-8-8.3. Former State and Legislative Employees; Health Benefit Plans
5-10-8-8.4. Revocation or Alteration by Employer
5-10-8-8.5. Establishment of Retiree Health Benefit Trust Fund
5-10-8-9. Coverage of Services for Mental Illness
5-10-8-10. Examining Infants for Hiv; Payment
5-10-8-10.5. Dental Care Provisions Required
5-10-8-11. Use of Diagnostic or Procedure Codes
5-10-8-13. Mail Order or Internet Based Pharmacy
5-10-8-14. Coverage for Prosthetic Devices
5-10-8-14.8. Employee Health Plan Providing Coverage for Prescription Eye Drops
5-10-8-14.9. Coverage of Methadone
5-10-8-15. Coverage for Care Related to Cancer Clinical Trials
5-10-8-16. High Breast Density
5-10-8-16.5. Post-Mastectomy Coverage
5-10-8-17. Step Therapy Protocol
5-10-8-18. Prescription Drug Coverage
5-10-8-19. Prior Authorization
5-10-8-21. Coverage for Anatomical Gifts, Transplantation, or Related Health Care Services
5-10-8-22. Coverage for Chronic Pain Management
5-10-8-22.5. Amount Paid for Prescription Drug to Be Counted Against Deductible
5-10-8-23. Reimbursement for Emergency Medical Services
5-10-8-24. Coverage for Pediatric Neuropsychiatric Disorders