Utah Code 31A-22-630. Mastectomy coverage
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(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:
Terms Used In Utah Code 31A-22-630
- Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:(103)(a)(i) a policyholder;(103)(a)(ii) a subscriber;(103)(a)(iii) a member; and(103)(a)(iv) a beneficiary. See Utah Code 31A-1-301(1)(a) reconstruction of the breast on which the mastectomy has been performed;(1)(b) surgery and reconstruction of the breast on which the mastectomy was not performed to produce symmetrical appearance; and(1)(c) prostheses and physical complications with regards to all stages of mastectomy, including lymphedemas.
(2)
(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.
(2)(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:
(3)(a) upon enrollment; and
(3)(b) annually after the enrollment.