SLS 20RS-772 REENGROSSED
2020 Regular Session
SENATE BILL NO. 494
BY SENATOR CARTER
INSURANCE POLICIES. Provides relative to coverage for mastectomies and
reconstructive surgery. (1/1/21)
1 AN ACT
2 To amend and reenact R.S. 22:1077(A) and R.S. 22:1077(B) and (F)(1) as amended by Act
3 119 of the 2019 Regular Session, relative to reconstructive surgery following
4 mastectomies; to provide with respect to contralateral prophylactic mastectomies;
5 and to provide for related matters.
6 Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 22:1077(A) is hereby amended and reenacted to read as follows:
8 §1077. Required coverage for mastectomies and reconstructive surgery following
9 mastectomies
10 A. The legislature hereby finds that approximately three thousand women
11 will be diagnosed with breast cancer each year in Louisiana. Studies documenting
12 breast cancer statistics indicate that Louisiana has the highest mastectomy rate in the
13 nation: fifty-one percent of all women diagnosed with breast cancer will undergo a
14 mastectomy or bilateral mastectomy as part of their treatment regimen. Despite
15 laws which require insurers and physicians to inform women that breast
16 reconstruction is an insured surgical option, seven of ten women are not provided
17 this information. The purpose of this Section is to assure that state law mirrors the
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 494
SLS 20RS-772 REENGROSSED
1 federal Women's Health and Cancer Rights Act, to extend its application to all health
2 insurance issuers in Louisiana, to stress that decisions regarding mastectomies and
3 the reconstructive procedures to be performed shall be made solely by the patient in
4 consultation with attending physicians, and to clarify that mastectomies and all
5 stages of breast reconstruction as defined pursuant to this Section are medically
6 necessary and shall not be excluded from coverage.
7 * * *
8 Section 2. R.S. 22:1077(B) and (F)(1) as amended by Act 119 of the 2019 Regular
9 Session are hereby amended and reenacted to read as follows:
10 §1077. Required coverage for reconstructive surgery following mastectomies
11 * * *
12 B. Any health benefit plan offered by a health insurance issuer that provides
13 medical and surgical benefits with respect to a partial mastectomy or a full unilateral
14 or bilateral mastectomy shall also provide medical and surgical benefits for breast
15 reconstruction. The coverage shall be for mastectomies, including contralateral
16 prophylactic mastectomies, and breast reconstruction procedures selected by the
17 patient in consultation with attending physicians. The coverage provided in this
18 Section may be subject to annual deductibles, coinsurance, and copayment
19 provisions as are consistent with those established for mastectomy procedures under
20 the health benefit plan. Written notice of the availability of coverage shall be
21 delivered to the insured or enrollee upon enrollment and annually thereafter as
22 approved by the commissioner of insurance.
23 * * *
24 F. For purposes of this Section:
25 (1) "Breast reconstruction" means all stages of reconstruction of the breast
26 on which a mastectomy has been performed and on the other breast to produce a
27 symmetrical appearance, including but not limited to liposuction performed for
28 transfer to a reconstructed breast or to repair a donor site deformity, tattooing the
29 areola of the breast, surgical adjustments of the non-mastectomized breast,
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 494
SLS 20RS-772 REENGROSSED
1 unforeseen medical complications which may require additional reconstruction in the
2 future, and prostheses and physical complications, including but not limited to
3 lymphedemas.
4 (1) "Breast reconstruction" means both of the following:
5 (a) All stages of reconstruction of the breast on which a unilateral
6 mastectomy has been performed and on the other breast to produce a symmetrical
7 appearance, including but not limited to contralateral prophylactic mastectomies,
8 liposuction performed for transfer to a reconstructed breast or to repair a donor site
9 deformity, tattooing the areola of the breast, surgical adjustments of the
10 non-mastectomized breast, unforeseen medical complications which may require
11 additional reconstruction in the future, and prostheses and physical complications,
12 including but not limited to lymphedemas.
13 (b) All stages of reconstruction of both breasts if a bilateral mastectomy has
14 been performed, including but not limited to liposuction performed for transfer to a
15 reconstructed breast or to repair a donor site deformity, tattooing the areola of the
16 breast, unforeseen medical complications which may require additional
17 reconstruction in the future, and prostheses and physical complications, including but
18 not limited to lymphedemas.
19 * * *
20 Section 2.(A) This Act shall become effective on January 1, 2021.
21 (B) This Act shall apply to any new policy, contract, program, or health coverage
22 plan issued on or after January 1, 2021. Any policy, contract, or health coverage plan in
23 effect prior to January 1, 2021, shall convert to conform to the provisions of this Act on or
24 before the renewal date, but no later than January 1, 2022.
The original instrument was prepared by Cheryl B. Cooper. The following
digest, which does not constitute a part of the legislative instrument, was
prepared by LG Sullivan.
DIGEST
SB 494 Reengrossed 2020 Regular Session Carter
Present law requires health insurance coverage for reconstructive surgery following
mastectomies.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 494
SLS 20RS-772 REENGROSSED
Proposed law retains present law and includes the requirement of health insurance coverage
for contralateral prophylactic mastectomies.
Proposed law provides that proposed law shall apply to any new policy, contract, program,
or health coverage plan issued on or after January 1, 2021. Provides that any policy, contract,
or health coverage plan in effect prior to January 1, 2021, shall convert to conform to the
provisions of proposed law on or before the renewal date, but no later than January 1, 2022.
Effective January 1, 2021.
(Amends R.S. 22:1077 (A) and 1077(B) and (F)(1) as amended by Acts 2019, No. 119)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original
bill
1. Makes technical corrections.
Summary of Amendments Adopted by Senate
Senate Floor Amendments to engrossed bill
1. Provides for an effective date.
2. Provides a phase-in of the application of proposed law in calendar year 2021.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.