KRS 304.18-0983: Coverage for medical and surgical benefits with respect to

mastectomy, diagnosis and treatment of endometrioses and endometritis, and

bone density testing -- Duties of insurer.

(1) All insurers issuing group or blanket health insurance policies an d certificates in

this Commonwealth providing coverage on an expense -incurred basis shall make

available and offer to the purchaser coverage for:

(a) The following, if an insurer provides medical and surgical benefits with

respect to a mastectomy, in a man ner determined in consultation with the

attending physician and the covered person, and subject to annual deductibles

and coinsurance provisions as may be deemed appropriate and as are

consistent with those established for other benefits under the coverage:

1. All stages of breast reconstruction surgery of the breast on which the

mastectomy has been performed;

2. Surgery and reconstruction of the other breast to produce a symmetrical

appearance; and

3. Prostheses and physical complications of all stages of mastectomy,

including lymphedemas;

(b) Diagnosis and treatment of endometriosis and endometritis if the insurer also

covers hysterectomies; and

(c) Bone density testing for women age thirty -five (35) years and older, as

indicated by the health -care provide r, in accordance with standard medical

practice, to obtain baseline data for the purpose of early detection of

osteoporosis.

(2) No insurer under this section shall offer medical and surgical benefits with respect

to a mastectomy which requires the procedure be performed on an outpatient basis.

(3) An insurer shall provide written notice to a covered person of the availability of

medical and surgical benefits with respect to a mastectomy upon enrollment and

annually thereafter.

(4) An insurer shall not:

(a) Deny eligibility, or continued eligibility, to an individual to enroll or to renew

coverage under the terms of the plan, solely for the purpose of avoiding the

requirements of 42 U.S.C. sec. 300gg-6; and

(b) Penalize or otherwise reduce or limit the reimb ursement of an attending

provider or provide incentives to an attending provider, to induce the provider

to provide care to an individual in a manner inconsistent with 42 U.S.C. sec.

300gg-6.