Tex. Insurance Code § 1357.004
This is the official text of Tex. Insurance Code § 1357.004, part of Texas’s Insurance Code — regulates insurance companies and the policies they sell.
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§ 1357.004. COVERAGE REQUIRED.
Official statutory text
(a) A health benefit plan that provides coverage for mastectomy must provide coverage for:
(1) reconstruction of the breast on which the mastectomy has been performed;
(2) surgery and reconstruction of the other breast to achieve a symmetrical appearance; and
(3) prostheses and treatment of physical complications, including lymphedemas, at all stages of mastectomy.
(b) Coverage required under this section:
(1) shall be provided in a manner determined to be appropriate in consultation with the attending physician and the enrollee;
(2) may be subject to annual deductibles, copayments, and coinsurance that are consistent with annual deductibles, copayments, and coinsurance required for other coverage under the health benefit plan; and
(3) may not be subject to dollar limits other than the lifetime maximum benefits under the plan.
(1) reconstruction of the breast on which the mastectomy has been performed;
(2) surgery and reconstruction of the other breast to achieve a symmetrical appearance; and
(3) prostheses and treatment of physical complications, including lymphedemas, at all stages of mastectomy.
(b) Coverage required under this section:
(1) shall be provided in a manner determined to be appropriate in consultation with the attending physician and the enrollee;
(2) may be subject to annual deductibles, copayments, and coinsurance that are consistent with annual deductibles, copayments, and coinsurance required for other coverage under the health benefit plan; and
(3) may not be subject to dollar limits other than the lifetime maximum benefits under the plan.
Status: in_force · Read it on the official government site
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