Section 500.3616 - Coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services; coverage for breast cancer screening mammogra
THE INSURANCE CODE OF 1956 (EXCERPT)
Act 218 of 1956
500.3616 Coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services; coverage for breast cancer screening mammography; definitions; effective date of section.
Sec. 3616.
(1) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, an insurer which delivers, issues for delivery, or renews in this state a group hospital, medical, or surgical expense incurred policy shall offer or include coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services.
(2) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, an insurer which delivers, issues for delivery, or renews in this state a hospital, medical, or surgical expense incurred policy shall offer or include the following coverage for breast cancer screening mammography:
(a) If performed on a woman 35 years of age or older and under 40 years of age, coverage for 1 screening mammography examination during that 5-year period.
(b) If performed on a woman 40 years of age or older, coverage for 1 screening mammography examination every calendar year.
(3) As used in this section:
(a) “Breast cancer diagnostic services” means a procedure intended to aid in the diagnosis of breast cancer, delivered on an inpatient or outpatient basis, including but not limited to mammogram, mammography, surgical breast biopsy, and pathologic examination and interpretation.
(b) “Breast cancer rehabilitative services” means a procedure intended to improve the result of, or ameliorate the debilitating consequences of, treatment of breast cancer, delivered on an inpatient or outpatient basis, including but not limited to reconstructive plastic surgery, physical therapy, and psychological and social support services.
(c) “Breast cancer screening mammography” means a standard 2-view per breast, low-dose radiographic examination of the breasts, using equipment designed and dedicated specifically for mammography, in order to detect unsuspected breast cancer.
(d) “Breast cancer outpatient treatment services” means a procedure intended to treat cancer of the human breast, delivered on an outpatient basis, including but not limited to surgery, radiation therapy, chemotherapy, hormonal therapy, and related medical follow-up services.
(4) This section shall take effect November 1, 1989.
History: Add. 1989, Act 59, Eff. Nov. 1, 1989
Popular Name: Act 218