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Utah Code § 31A-22-630

Mastectomy coverage

Applied in 1 court decision — leading case Douglas S. v. Altius Health Plans, Inc. (2010)

Most recently applied in Douglas S. v. Altius Health Plans, Inc. (November 2010)

Amended by Chapter 116, 2001 General Session

(1) If an insured has coverage that provides medical and surgical benefits with respect to a mastectomy, it shall provide coverage, with consultation of the attending physician and the patient, for:

(a) reconstruction of the breast on which the mastectomy has been performed;

(b) surgery and reconstruction of the breast on which the mastectomy was not performed to produce symmetrical appearance; and

(c) prostheses and physical complications with regards to all stages of mastectomy, including lymphedemas.

(2)

(a) This section does not prevent an accident and health insurer from imposing cost-sharing measures for health benefits relating to this coverage, if cost-sharing measures are not greater than those imposed on any other medical condition.

(b) For purposes of this Subsection (2), cost-sharing measures include imposing a deductible or coinsurance requirement.

(3) Written notice of the availability of the coverage described in Subsection (1) shall be delivered to the participant:

(a) upon enrollment; and

(b) annually after the enrollment.

Official source: Utah State Legislature. Reproduced from public-domain Utah statutes; confirm against the official source for the current text. Not legal advice.