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36-6060.5.


36-6060.5.
   
   A. This section shall be known and may be cited as the "Oklahoma
   Breast Cancer Patient Protection Act".
   
   B. Any health benefit plan that is offered, issued or renewed in this
   state on or after January 1, 1998, that provides medical and surgical
   benefits with respect to the treatment of breast cancer and other
   breast conditions shall ensure that coverage is provided for not less
   than forty-eight (48) hours of inpatient care following a mastectomy
   and not less than twenty-four (24) hours of inpatient care following a
   lymph node dissection for the treatment of breast cancer.
   
   C. Nothing in this section shall be construed as requiring the
   provision of inpatient coverage where the attending physician in
   consultation with the patient determines that a shorter period of
   hospital stay is appropriate.
   
   D. Any plan subject to subsection B of this section shall also provide
   coverage for reconstructive breast surgery performed as a result of a
   partial or total mastectomy, except as prohibited by federal laws or
   regulations pertaining to Medicaid. Because breasts are a paired
   organ, any such reconstructive breast surgery shall include coverage
   for all stages of reconstructive breast surgery performed on a
   nondiseased breast to establish symmetry with a diseased breast when
   reconstructive surgery on the diseased breast is performed, provided
   that the reconstructive surgery and any adjustments made to the
   nondiseased breast must occur within twenty-four (24) months of
   reconstruction of the diseased breast.
   
   E. In implementing the requirements of this section, a health benefit
   plan may not modify the terms and conditions of coverage based on the
   determination by an enrollee to request less than the minimum coverage
   required pursuant to subsections B and D of this section.
   
   F. A health benefit plan shall provide notice to each insured or
   enrollee under such plan regarding the coverage required by this
   section in the plan's evidence of coverage, and shall provide
   additional written notice of the coverage to the insured or enrollee
   as follows:
   
   1. In the next mailing made by the plan to the employee;
   
   2. As part of any yearly informational packet sent to the enrollee; or
   
   3. Not later than December 1, 1997;
   
   whichever is earlier.
   
   G. As used in this act, "health benefit plan" means any plan or
   arrangement as defined in subsection G of Section 6060.3 of Title 36
   of the Oklahoma Statutes.
   
   H. The Insurance Commissioner shall promulgate any rules necessary to
   implement the provisions of this section.
   

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