{"data":{"id":"us-ky/krs-304.38-1934","jurisdiction":"us-ky","citation":"KRS 304.38-1934","heading":"Coverage for medical and surgical benefits with respect to","body":"mastectomy, diagnosis and treatment of endometrioses and endometritis, and\nbone density testing -- Duties of health maintenance organization.\n(1) Health maintenance organizations issuing c ontracts in this Commonwealth that\nprovide hospital, medical, or surgical expense benefits shall make available and\noffer to the purchaser coverage for:\n(a) The following, if a health maintenance organization provides medical and\nsurgical benefits with res pect to a mastectomy, in a manner determined in\nconsultation with the attending physician and the covered person, and subject\nto annual deductibles and coinsurance provisions as may be deemed\nappropriate and as are consistent with those established for oth er benefits\nunder the coverage:\n1. All stages of breast reconstruction surgery of the breast on which the\nmastectomy has been performed;\n2. Surgery and reconstruction of the other breast to produce a symmetrical\nappearance; and\n3. Prostheses and physical c omplications of all stages of mastectomy,\nincluding lymphedemas;\n(b) Diagnosis and treatment of endometriosis if the health maintenance\norganization also covers hysterectomies; and\n(c) Bone density testing for women age thirty -five (35) years and older, as\nindicated by the health -care provider, in accordance with standard medical\npractice, to obtain baseline data for the purpose of early detection of\nosteoporosis.\n(2) No health maintenance organization under this section shall offer medical and\nsurgical ben efits with respect to mastectomy that requires the procedure be\nperformed on an outpatient basis.\n(3) A health maintenance organization shall provide written notice to a covered person\nof the availability of medical and surgical benefits with respect to a mastectomy\nupon enrollment and annually thereafter.\n(4) A health maintenance organization shall not:\n(a) Deny eligibility, or continued eligibility, to an individual to enroll or to renew\ncoverage under the terms of the plan, solely for the purpose of avoi ding the\nrequirements of 42 U.S.C. secs. 300gg-6 and 300gg-52; and\n(b) Penalize or otherwise reduce or limit the reimbursement of an attending\nprovider or provide incentives to an attending provider, to induce the provider\nto provide care to an individual in a manner inconsistent with 42 U.S.C. secs.\n300gg-6 and 300gg-52.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=29993","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:56Z","sha256":"e34ca94f7affb8096741d34d632a70eed63772956ba3f9170cd78af940cc7d59","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.38-1933","next":"us-ky/krs-304.38-1935"},"notice":"GroundRules: Original legal text. Not legal advice."}