Sec. 6. (a) Except as provided in subsection (f), an insurer must provide coverage for breast cancer screening mammography in any accident and sickness insurance policy that the insurer issues in Indiana.

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Terms Used In Indiana Code 27-8-14-6

  • accident and sickness insurance policy: means an insurance policy that:

    Indiana Code 27-8-14-1

  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • breast cancer screening mammography: means a standard, two (2) view per breast, low-dose radiographic examination of the breasts that is:

    Indiana Code 27-8-14-2

  • Contract: A legal written agreement that becomes binding when signed.
  • insured: means an individual who is entitled to coverage under a policy of accident and sickness insurance. See Indiana Code 27-8-14-3
  • woman at risk: means a woman who meets at least one (1) of the following descriptions:

    Indiana Code 27-8-14-5

  • Year: means a calendar year, unless otherwise expressed. See Indiana Code 1-1-4-5
     (b) Except as provided in subsection (f), the coverage that an insurer must provide under this section must include the following:

(1) If the insured is at least thirty-five (35) but less than forty (40) years of age, coverage for at least one (1) baseline breast cancer screening mammography performed upon the insured before she becomes forty (40) years of age.

(2) If the insured is:

(A) less than forty (40) years of age; and

(B) a woman at risk;

one (1) breast cancer screening mammography performed upon the insured every year.

(3) If the insured is at least forty (40) years of age, one (1) breast cancer screening mammography performed upon the insured every year.

(4) Any additional mammography views that are required for proper evaluation.

(5) Ultrasound services, if determined medically necessary by the physician treating the insured.

     (c) Except as provided in subsection (f), the coverage that an insurer must provide under this section must provide reimbursement for breast cancer screening mammography at a level at least as high as:

(1) the limitation on payment for screening mammography services established in 42 C.F.R. § 405.534(b)(3) according to the Medicare Economic Index at the time the breast cancer screening mammography is performed; or

(2) the rate negotiated by a contract provider according to the provisions of the insurance policy;

whichever is lower.

     (d) Except as provided in subsection (f), the coverage that an insurer must provide under this section may not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to the insured than the dollar limits, deductibles, or coinsurance provisions applying to physical illness generally under the accident and sickness insurance policy.

     (e) Except as provided in subsection (f), the coverage that an insurer must provide is in addition to any benefits specifically provided for x-rays, laboratory testing, or wellness examinations.

     (f) In the case of insurance policies that are not employer based, the insurer must offer to provide the coverage described in subsections (a) through (e).

As added by P.L.119-1991, SEC.3. Amended by P.L.170-1999, SEC.3.

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