(a) On and after January 1, 2026, a health benefit plan that is offered, issued, or renewed in this state shall provide coverage for all modalities, types, and techniques of a healthcare service provided for a breast reconstruction surgery and shall cover any surgery determined as the best course of treatment by a healthcare professional, consistent with prevailing medical standards, and in consultation with the patient.
(b) The coverage for breast reconstruction surgery under this section:(1) Shall be subject to policy deductibles, copayment requirements, or coinsurance requirements of a healthcare insurer at a cost that is no more than those costs associated with the health benefit plan's in-network rate for the healthcare service;(2) Does not diminish or limit benefits otherwise allowable under a health benefit plan; and(3) Shall not affect an enrollee's eligibility or continued eligibility to enroll or renew coverage under the terms of the health benefit plan solely for the purpose of avoiding the requirements of this subchapter.
(1) Shall be subject to policy deductibles, copayment requirements, or coinsurance requirements of a healthcare insurer at a cost that is no more than those costs associated with the health benefit plan's in-network rate for the healthcare service;
(2) Does not diminish or limit benefits otherwise allowable under a health benefit plan; and
(3) Shall not affect an enrollee's eligibility or continued eligibility to enroll or renew coverage under the terms of the health benefit plan solely for the purpose of avoiding the requirements of this subchapter.
(c) If an enrollee is forced to use an out-of-network provider due to a healthcare insurer's network inadequacy, the enrollee's financial responsibility shall remain at an in-network rate.