KRS 304.38-1934: Coverage for medical and surgical benefits with respect to

mastectomy, diagnosis and treatment of endometrioses and endometritis, and

bone density testing -- Duties of health maintenance organization.

(1) Health maintenance organizations issuing c ontracts in this Commonwealth that

provide hospital, medical, or surgical expense benefits shall make available and

offer to the purchaser coverage for:

(a) The following, if a health maintenance organization provides medical and

surgical benefits with res pect to a mastectomy, in a manner 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 oth er 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 c omplications of all stages of mastectomy,

including lymphedemas;

(b) Diagnosis and treatment of endometriosis if the health maintenance

organization also covers hysterectomies; and

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

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

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

osteoporosis.

(2) No health maintenance organization under this section shall offer medical and

surgical ben efits with respect to mastectomy that requires the procedure be

performed on an outpatient basis.

(3) A health maintenance organization 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) A health maintenance organization 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 avoi ding the

requirements of 42 U.S.C. secs. 300gg-6 and 300gg-52; and

(b) Penalize or otherwise reduce or limit the reimbursement 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. secs.

300gg-6 and 300gg-52.