§36-6060.5. Oklahoma Breast Cancer Patient Protection Act.
427 words·~2 min read·
/ok/title-36-insurance/36-6060-5·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A. This section shall be known and may be cited as the "Oklahoma Breast Cancer Patient Protection Act".
B. Any health benefit plan that is offered, issued or renewed in this state on or after January 1, 1998, that provides medical and surgical benefits with respect to the treatment of breast cancer and
other breast conditions shall ensure that coverage is provided for not less than forty-eight
(48)hours of inpatient care following a mastectomy and not less than twenty-four
(24)hours of inpatient care following a lymph node dissection for the treatment of breast cancer.
C. Nothing in this section shall be construed as requiring the provision of inpatient coverage where the attending physician in consultation with the patient determines that a shorter period of hospital stay is appropriate.
D. Any plan subject to subsection B of this section shall also provide coverage for reconstructive breast surgery performed as a result of a partial or total mastectomy. Because breasts are a paired organ, any such reconstructive breast surgery shall include coverage for all stages of reconstructive breast surgery performed on a nondiseased breast to establish symmetry with a diseased breast when reconstructive surgery on the diseased breast is performed, provided that the reconstructive surgery and any adjustments made to the nondiseased breast must occur within twenty-four
(24)months of reconstruction of the diseased breast.
E. In implementing the requirements of this section, a health benefit plan may not modify the terms and conditions of coverage based on the determination by an enrollee to request less than the minimum coverage required pursuant to subsections B and D of this section.
F. A health benefit plan shall provide notice to each insured or enrollee under the plan regarding the coverage required by this section in the evidence of coverage of the plan, and shall provide additional written notice of the coverage to the insured or enrollee as follows:
1. In the next mailing made by the plan to the employee;
2. As part of any yearly informational packet sent to the enrollee; or
3. Not later than December 1, 1997; whichever is earlier.
G. As used in this act, "health benefit plan" means any plan or arrangement as defined in subsection C of Section 6060.4 of this title.
H. The Insurance Commissioner shall promulgate any rules necessary to implement the provisions of this section. Added by Laws 1997, c. 135, § 1, eff. Nov. 1, 1997. Amended by Laws 2003, c. 464, § 7, eff. July 1, 2003; Laws 2010, c. 222, § 35, eff. Nov. 1, 2010.