It is enacted by the General Assembly as follows:

SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section:

{ADD 27-18-39. Mastectomy treatment. -- ADD} {ADD Every individual or group health insurance contract, plan, or policy delivered, issued for delivery or renewed in this state on or after January 1, 1997, which provides medical coverage that includes coverage for physician services in a physician's office and every policy which provides major medical or similar comprehensive-type coverage excluding supplemental policies which only provide coverage for specified diseases or other supplemental policies shall include coverage for prosthetic devices and or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy and all other terms and conditions applicable to other benefits. Any reconstructive surgery under this section must be performed within eighteen (18) months of the original mastectomy. As used in this section, "mastectomy" means the removal of all or part of the breast to treat breast cancer, tumor, or mass.

Any provision in any contract issued, amended, delivered or renewed in this state on or after January 1, 1997, which is in conflict with this section shall be of no force or effect.

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 or surgeon.

Nothing in this section shall be construed to require an individual or group policy to cover the surgical procedure known as mastectomy or to prevent application of deductible or copayment provisions contained in the policy or plan, nor shall this section be construed to require that coverage under an individual or group policy be extended to any other procedures.

Nothing in this section shall be construed to authorize an insured or plan member to receive the coverage required by this section if that coverage is furnished by a nonparticipating provider, unless the insured or plan member is referred to that provider by a participating physician, nurse practitioner, or certified nurse midwife providing care.

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. ADD}

SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporation" is hereby amended by adding thereto the following section:

{ADD 27-19-34. Mastectomy treatment. -- ADD} {ADD Every individual or group health insurance contract, plan, or policy delivered, issued for delivery or renewed in this state on or after January 1, 1997, which provides medical coverage that includes coverage for physician services in a physician's office and every policy which provides major medical or similar comprehensive-type coverage shall include coverage for prosthetic devices and or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy and all other terms and conditions applicable to other benefits. Any reconstructive surgery under this section must be performed within eighteen (18) months of the original mastectomy. As used in this section, "mastectomy" means the removal of all or part of the breast to treat a breast cancer, tumor, or mass.

Any provision in any contract issued, amended, delivered or renewed in this state on or after January 1, 1997, which is in conflict with this section shall be of no force or effect.

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 or surgeon.

Nothing in this section shall be construed to require an individual or group policy to cover the surgical procedure known as mastectomy or to prevent application of deductible or copayment provisions contained in the policy or plan, nor shall this section be construed to require that coverage under an individual or group policy be extended to any other procedures.

Nothing in this section shall be construed to authorize an insured or plan member to receive the coverage required by this section if that coverage is furnished by a nonparticipating provider, unless the insured or plan member is referred to that provider by a participating physician, nurse practitioner, or certified nurse midwife providing care.

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. ADD}

SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporation" is hereby amended by adding thereto the following section:

{ADD 27-20-21. Mastectomy treatment. -- ADD} {ADD Every individual or group health insurance contract, plan, or policy delivered, issued for delivery or renewed in this state on or after January 1, 1997, which provides medical coverage that includes coverage for physician services in a physician's office and every policy which provides major medical or similar comprehensive-type coverage shall include coverage for prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy and all other terms and conditions applicable to other benefits. Any reconstructive surgery under this section must be performed within eighteen (18) months of the original mastectomy. As used in this section, "mastectomy" means the removal of all or part of the breast to treat a breast cancer, tumor, or mass.

Any provision in any contract issued, amended, delivered or renewed in this state on or after January 1, 1997, which is in conflict with this section shall be of no force or effect.

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 or surgeon.

Nothing in this section shall be construed to require an individual or group policy to cover the surgical procedure known as mastectomy or to prevent application of deductible or copayment provisions contained in the policy or plan, nor shall this section be construed to require that coverage under an individual or group policy be extended to any other procedures.

Nothing in this section shall be construed to authorize an insured or plan member to receive the coverage required by this section if that coverage is furnished by a nonparticipating provider, unless the insured or plan member is referred to that provider by a participating physician, nurse practitioner, or certified nurse midwife providing care.

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. ADD}

SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section:

{ADD 27-41-43. Mastectomy treatment. -- ADD} {ADD Every individual or group health insurance contract, plan, or policy delivered, issued for delivery or renewed in this state on or after January 1, 1997, which provides medical coverage that includes coverage for physician services in a physician's office and every policy which provides major medical or similar comprehensive-type coverage shall include coverage for prosthetic devices and or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy and all other terms and conditions applicable to other benefits. Any reconstructive surgery under this section must be performed within eighteen (18) months of the original mastectomy. As used in this section, "mastectomy" means the removal of all or part of the breast to treat a breast cancer, tumor, or mass.

Any provision in any contract issued, amended, delivered or renewed in this state on or after January 1, 1997, which is in conflict with this section shall be of no force or effect.

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 or surgeon.

Nothing in this section shall be construed to require an individual or group policy to cover the surgical procedure known as mastectomy or to prevent application of deductible or copayment provisions contained in the policy or plan, nor shall this section be construed to require that coverage under an individual or group policy be extended to any other procedures.

Nothing in this section shall be construed to authorize an insured or plan member to receive the coverage required by this section if that coverage is furnished by a nonparticipating provider, unless the insured or plan member is referred to that provider by a participating physician, nurse practitioner, or certified nurse midwife providing care.

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. ADD}

SECTION 5. This act shall take effect upon passage.