§ 27-18-39. Mastectomy treatment.
(a) All individual or group health insurance coverage and health-benefit plans delivered, issued for delivery, or renewed in this state on or after January 1, 2005, that provide medical and surgical benefits with respect to mastectomy, excluding supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall provide, in a case of any person covered in the individual market or covered by a group health plan, coverage for:
(1) Reconstruction of the breast on which the mastectomy has been performed;
(2) Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
(3) Prostheses and treatment of physical complications, including lymphademas, at all stages of mastectomy; in a manner determined in consultation with the attending physician, physician assistant as defined in § 5-54-2, or an advance practice registered nurse as defined in § 5-34-3, and the patient. As used in this section, “mastectomy” means the removal of all or part of a breast. Written notice of the availability of this coverage shall be delivered to the participant upon enrollment and annually thereafter.
(b) As used in this section, “prosthetic devices” means and includes the provision of initial and subsequent prosthetic devices pursuant to an order of the patient’s physician, physician assistant, advance practice registered nurse, or surgeon.
(c) [Deleted by P.L. 2018, ch. 114, § 1 and P.L. 2018, ch. 204, § 1].
(d) Nothing in this section shall be construed to prevent a group health plan or a health insurance carrier offering health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.
(e) Nothing in this section shall preclude the conducting of managed-care reviews and medical-necessity reviews, by an insurer, hospital or medical-service corporation or health-maintenance organization.
(f) Notice. A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, shall provide notice to each participant and beneficiary under the plan regarding the coverage required by this section in accordance with regulations promulgated by the United States Secretary of Health and Human Services. The notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted as part of any yearly informational packet sent to the participant or beneficiary.
(g) Prohibitions. A group health plan and a health insurance carrier offering group or individual health insurance coverage may not:
(1) Deny to a patient eligibility, or continued eligibility, to enroll or renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section; nor
(2) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide incentives (monetary or otherwise) to an attending provider, to induce the provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section.
History of Section.P.L. 1996, ch. 66, § 1; P.L. 2002, ch. 292, § 33; P.L. 2004, ch. 41, § 1; P.L. 2004, ch. 45, § 1; P.L. 2018, ch. 114, § 1; P.L. 2018, ch. 204, § 1.
Structure Rhode Island General Laws
Chapter 27-18 - Accident and Sickness Insurance Policies
Section 27-18-1. - “Policy of accident and sickness insurance” construed.
Section 27-18-1.1. - Definitions.
Section 27-18-2. - Form of policy.
Section 27-18-2.1. - Uniform explanation of benefits and coverage.
Section 27-18-3. - Required provisions.
Section 27-18-3.1. - Alternative coverage by employer.
Section 27-18-3.2. - Rules and regulations.
Section 27-18-3.3. - Penalties.
Section 27-18-3.4. - Judicial review.
Section 27-18-3.5. - Non-applicability.
Section 27-18-4. - Optional provisions.
Section 27-18-5. - Inapplicable or inconsistent provisions.
Section 27-18-6. - Sequence of provisions.
Section 27-18-7. - Third party ownership.
Section 27-18-8. - Filing of accident and sickness insurance policy forms.
Section 27-18-8.1. - Waiting period — Effective date of filings.
Section 27-18-8.2. - Notice of disapproval.
Section 27-18-8.3. - Withdrawal of approval.
Section 27-18-8.4. - Rules as to filing.
Section 27-18-9. - Policies of foreign insurers.
Section 27-18-10. - Compliance by domestic insurer with laws of other states.
Section 27-18-11. - Application of provisions to policy issued to nonresident.
Section 27-18-12. - Less favorable provisions prohibited.
Section 27-18-13. - Effect of policies inconsistent with chapter.
Section 27-18-14. - Copies of applications.
Section 27-18-15. - Alteration of application.
Section 27-18-16. - False statements in application.
Section 27-18-17. - Acts not constituting waiver of insurer’s defenses.
Section 27-18-18. - Acceptance of premiums after effective period of policy.
Section 27-18-19. - Insurance exempt from chapter.
Section 27-18-20. - Penalties for violations.
Section 27-18-21. - Appeals from commissioner.
Section 27-18-22. - Effect on other law.
Section 27-18-23. - Severability.
Section 27-18-24. - Immunity of benefits from process.
Section 27-18-25. - Unfair discrimination prohibited.
Section 27-18-26. - Physical examinations by insurance company.
Section 27-18-27. - Adoptive children.
Section 27-18-28. - [Repealed.]
Section 27-18-29. - Changing coverage.
Section 27-18-30. - Health insurance contracts — Infertility.
Section 27-18-31. - Insurance coverage for services of licensed midwives.
Section 27-18-32. - Discontinuance of coverage — Chronic disabilities.
Section 27-18-33. - Drug coverage.
Section 27-18-33.1. - Insurance coverage for post-partum hospital stays.
Section 27-18-36.1. - Repealed.
Section 27-18-36.2. - Repealed.
Section 27-18-36.3. - Repealed.
Section 27-18-38. - Diabetes treatment.
Section 27-18-39. - Mastectomy treatment.
Section 27-18-40. - Insurance coverage for mastectomy hospital stays.
Section 27-18-41. - Mammograms and pap smears — Coverage mandated.
Section 27-18-42. - Mammograms — Quality assurance standards.
Section 27-18-43. - Pap smears — Quality assurance standards.
Section 27-18-44. - Primary and preventive obstetric and gynecological care.
Section 27-18-44.1. - Hysterectomy or myomectomy treatment.
Section 27-18-45. - Whistleblowers protection.
Section 27-18-46. - Penalties and remedies.
Section 27-18-47. - Additional relief and damages — Reinstatement.
Section 27-18-48. - Third party reimbursement for services of certain healthcare workers.
Section 27-18-48.1. - Third party reimbursement for services of registered nurse first assistants.
Section 27-18-49. - Human leukocyte antigen testing.
Section 27-18-50. - Drug coverage.
Section 27-18-50.1. - Medication synchronization.
Section 27-18-51. - Restricted annual rate payments prohibited.
Section 27-18-52. - Genetic testing.
Section 27-18-52.1. - Genetic information.
Section 27-18-53. - Magnetic resonance imaging — Quality assurance standards.
Section 27-18-54. - Health insurance rates.
Section 27-18-55. - Acupuncture services.
Section 27-18-56. - Prohibition against dentists being required to indemnify provider.
Section 27-18-57. - F.D.A. approved prescription contraceptive drugs and devices.
Section 27-18-59. - Eligibility for children’s benefits.
Section 27-18-60. - Hearing aids.
Section 27-18-61. - Prompt processing of claims.
Section 27-18-62. - Mandatory coverage for certain lyme disease treatments.
Section 27-18-63. - Dental insurance assignment of benefits.
Section 27-18-64. - Coverage for early intervention services.
Section 27-18-65. - Post-payment audits.
Section 27-18-66. - Tobacco cessation programs.
Section 27-18-67. - Reimbursement for orthotic and prosthetic services.
Section 27-18-68. - Mandatory coverage for scalp hair prosthesis.
Section 27-18-69. - Licensed ambulance service.
Section 27-18-70. - Enteral nutrition products.
Section 27-18-71. - Prohibition on preexisting condition exclusions.
Section 27-18-72. - Prohibition on rescission of coverage.
Section 27-18-73. - Prohibition on annual and lifetime limits.
Section 27-18-74. - Coverage for individuals participating in approved clinical trials.
Section 27-18-75. - Medical loss ratio reporting and rebates.
Section 27-18-76. - Emergency services.
Section 27-18-77. - Internal and external appeal of adverse benefit determinations.
Section 27-18-78. - Primary care provider designation requirement.
Section 27-18-79. - Discretionary clauses.
Section 27-18-80. - Orally administered anticancer medication — Cost-sharing requirement.
Section 27-18-81. - Consumer notification.
Section 27-18-82. - Opioid antagonists.
Section 27-18-83. - Healthcare provider credentialing.
Section 27-18-84. - Health insurance contracts — Full year coverage for contraception.
Section 27-18-85. - Prohibition on discrimination in organ transplants.
Section 27-18-86. - Health insurance contracts — Copayments exemption for COVID-19 vaccinations.
Section 27-18-87. - Perinatal doulas.
Section 27-18-88. - Gender rating. [Effective January 1, 2023.]