Sec. 38a-542. Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prothesis, chemotherapy and wigs. Mandatory coverage for breast reconstruction aft
Sec. 38a-542. Mandatory coverage for treatment of tumors and leukemia.
Mandatory coverage for reconstructive surgery, prothesis, chemotherapy and
wigs. Mandatory coverage for breast reconstruction after mastectomy. (a) Each
insurance company, hospital service corporation, medical service corporation, health
care center or fraternal benefit society which delivers or issues for delivery in this state
group health insurance policies providing coverage of the type specified in subdivisions
(1), (2), (4), (11) and (12) of section 38a-469 shall provide coverage under such policies
for treatment of leukemia, including outpatient chemotherapy, reconstructive surgery,
cost of any nondental prosthesis, including any maxillo-facial prosthesis used to replace
anatomic structures lost during treatment for head and neck tumors or additional appliances essential for the support of such prosthesis, outpatient chemotherapy following
surgical procedures in connection with the treatment of tumors, a wig if prescribed by
a licensed oncologist for a patient who suffers hair loss as a result of chemotherapy, and
costs of removal of any breast implant which was implanted on or before July 1, 1994,
without regard to the purpose of such implantation, which removal is determined to be
medically necessary. Such benefits shall be subject to the same terms and conditions
applicable to all other benefits under such policies.
(b) Except as provided in subsection (c) of this section, the coverage required by
subsection (a) of this section shall provide at least a yearly benefit of one thousand
dollars for the costs of removal of any breast implant, five hundred dollars for the surgical
removal of tumors, five hundred dollars for reconstructive surgery, five hundred dollars
for outpatient chemotherapy, three hundred fifty dollars for a wig and three hundred
dollars for prosthesis, except that for purposes of the surgical removal of breasts due to
tumors the yearly benefit for prosthesis shall be at least three hundred dollars for each
breast removed.
(c) The coverage required by subsection (a) of this section shall provide benefits
for the reasonable costs of reconstructive surgery on each breast on which a mastectomy
has been performed, and reconstructive surgery on a nondiseased breast to produce a
symmetrical appearance. Such benefits shall be subject to the same terms and conditions
applicable to all other benefits under such policies. For the purposes of this subsection,
reconstructive surgery includes, but is not limited to, augmentation mammoplasty, reduction mammoplasty and mastopexy.
(P.A. 90-243, S. 123; P.A. 94-71, S. 12; P.A. 97-198, S. 4, 5; P.A. 04-34, S. 2.)
History: P.A. 94-71 amended Subsec. (a) by adding a provision to cover the cost of removal of any breast implant
which was implanted on or before July 1, 1994, without regard to the purpose of the implantation, provided the removal
is determined to be medically necessary and added a provision in Subsec. (b) for a benefit of $1,000 for the costs of removal
of the breast implant; P.A. 97-198 deleted provision from Subsec. (a) re coverage for the surgical removal of tumors, added
exception to Subsec. (b) and added Subsec. (c) re reconstructive surgery after mastectomy, effective July 1, 1997; P.A.
04-34 amended Subsec. (a) to substitute "Each" for "Any" and require coverage for a wig if prescribed for a patient who
suffers hair loss as a result of chemotherapy and amended Subsec. (b) to require a yearly benefit of $350 for a wig.
See Sec. 38a-504 for similar provisions re individual policies.