CHAPTER 14. COVERAGE FOR SERVICES RELATED TO BREAST CANCER SCREENING
IC 27-8-14
Chapter 14. Coverage for Services Related to Breast Cancer
Screening
IC 27-8-14-1
"Accident and sickness insurance policy"
Sec. 1. (a) As used in this chapter, "accident and sickness
insurance policy" means an insurance policy that:
(1) provides one (1) or more of the types of insurance described
in IC 27-1-5-1, classes 1(b) and 2(a); and
(2) is issued on a group basis.
(b) The term does not include the following:
(1) Accident only, credit, dental, vision, Medicare supplement,
long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Worker's compensation or similar insurance.
(4) Automobile medical payment insurance.
(5) A specified disease policy.
(6) A short term insurance plan that:
(A) may not be renewed; and
(B) has a duration of not more than six (6) months.
(7) A policy that provides indemnity benefits not based on any
expense incurred requirement, including a plan that provides
coverage for:
(A) hospital confinement, critical illness, or intensive care;
or
(B) gaps for deductibles or copayments.
(8) A supplemental plan that always pays in addition to other
coverage.
(9) A student health plan.
(10) An employer sponsored health benefit plan that is:
(A) provided to individuals who are eligible for Medicare;
and
(B) not marketed as, or held out to be, a Medicare
supplement policy.
As added by P.L.119-1991, SEC.3. Amended by P.L.173-2007,
SEC.30.
IC 27-8-14-2
"Breast cancer screening mammography"
Sec. 2. (a) As used in this chapter, "breast cancer screening
mammography" means a standard, two (2) view per breast, low-dose
radiographic examination of the breasts that is:
(1) furnished to an asymptomatic woman; and
(2) performed by a mammography services provider using
equipment designed by the manufacturer for and dedicated
specifically to mammography in order to detect unsuspected
breast cancer.
(b) The term includes the interpretation of the results of a breast
cancer screening mammography by a physician.
As added by P.L.119-1991, SEC.3.
IC 27-8-14-3
"Insured"
Sec. 3. As used in this chapter, "insured" means an individual who
is entitled to coverage under a policy of accident and sickness
insurance.
As added by P.L.119-1991, SEC.3.
IC 27-8-14-4
"Mammography services provider"
Sec. 4. As used in this chapter, "mammography services provider"
means a person or facility that:
(1) has been accredited by the American College of Radiology;
(2) meets equivalent guidelines established by the state
department of health; or
(3) certified by the Federal Department of Health and Human
Services for participation in the Medicare program (42 U.S.C.
1395 et seq.).
As added by P.L.119-1991, SEC.3. Amended by P.L.2-1992,
SEC.787.
IC 27-8-14-5
"Woman at risk"
Sec. 5. As used in this chapter, "woman at risk" means a woman
who meets at least one (1) of the following descriptions:
(1) A woman who has a personal history of breast cancer.
(2) A woman who has a personal history of breast disease that
was proven benign by biopsy.
(3) A woman whose mother, sister, or daughter has had breast
cancer.
(4) A woman who is at least thirty (30) years of age and has not
given birth.
As added by P.L.119-1991, SEC.3.
IC 27-8-14-6
Breast cancer screening mammography; coverage
Sec. 6. (a) Except as provided in subsection (f), an insurer must
provide coverage for breast cancer screening mammography in any
accident and sickness insurance policy that the insurer issues in
Indiana.
(b) Except as provided in subsection (f), the coverage that an
insurer must provide under this section must include the following:
(1) If the insured is at least thirty-five (35) but less than forty
(40) years of age, coverage for at least one (1) baseline breast
cancer screening mammography performed upon the insured
before she becomes forty (40) years of age.
(2) If the insured is:
(A) less than forty (40) years of age; and
(B) a woman at risk;
one (1) breast cancer screening mammography performed upon
the insured every year.
(3) If the insured is at least forty (40) years of age, one (1)
breast cancer screening mammography performed upon the
insured every year.
(4) Any additional mammography views that are required for
proper evaluation.
(5) Ultrasound services, if determined medically necessary by
the physician treating the insured.
(c) Except as provided in subsection (f), the coverage that an
insurer must provide under this section must provide reimbursement
for breast cancer screening mammography at a level at least as high
as:
(1) the limitation on payment for screening mammography
services established in 42 CFR 405.534(b)(3) according to the
Medicare Economic Index at the time the breast cancer
screening mammography is performed; or
(2) the rate negotiated by a contract provider according to the
provisions of the insurance policy;
whichever is lower.
(d) Except as provided in subsection (f), the coverage that an
insurer must provide under this section may not be subject to dollar
limits, deductibles, or coinsurance provisions that are less favorable
to the insured than the dollar limits, deductibles, or coinsurance
provisions applying to physical illness generally under the accident
and sickness insurance policy.
(e) Except as provided in subsection (f), the coverage that an
insurer must provide is in addition to any benefits specifically
provided for x-rays, laboratory testing, or wellness examinations.
(f) In the case of insurance policies that are not employer based,
the insurer must offer to provide the coverage described in
subsections (a) through (e).
As added by P.L.119-1991, SEC.3. Amended by P.L.170-1999,
SEC.3.