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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle E. BENEFITS PAYABLE UNDER HEALTH COVERAGES |
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Chapter 1357. MASTECTOMY |
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Subchapter A. RECONSTRUCTIVE SURGERY FOLLOWING MASTECTOMY |
Sec. 1357.004. COVERAGE REQUIRED
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(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.