§ 550.1416

550.1416 Coverage for breast cancer diagnostic services, breast cancer outpatient services, and breast cancer rehabilitative services; coverage for breast cancer screening mammography; definitions; effective date of section. Sec. 416. (1) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, a health care corporation shall offer or include, in each group and nongroup certificate, coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services. (2) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, a health care corporation shall offer or include, in each group and nongroup certificate, the following coverage for breast cancer screening mammography: (a) If performed on a woman 35 years of age or older and under 40 years of age, coverage for 1 screening mammography examination during that 5-year period. (b) If performed on a woman 40 years of age or older, coverage for 1 screening mammography examination every calendar year.

coverage for 1 screening mammography examination during that 5-year period. (b) If performed on a woman 40 years of age or older, coverage for 1 screening mammography examination every calendar year. (3) As used in this section: (a) 'Breast cancer diagnostic services' means a procedure intended to aid in the diagnosis of breast cancer, delivered on an inpatient or outpatient basis, including but not limited to mammography, surgical breast biopsy, and pathologic examination and interpretation. (b) 'Breast cancer rehabilitative services' means a procedure intended to improve the result of, or ameliorate the debilitating consequences of, treatment of breast cancer, delivered on an inpatient or outpatient basis, including but not limited to, reconstructive plastic surgery, physical therapy, and psychological and social support services. (c) 'Breast cancer screening mammography' means a standard 2-view per breast, low-dose radiographic examination of the breasts, using equipment designed and dedicated specifically for mammography, in order to detect unsuspected breast cancer. (d) 'Breast cancer outpatient treatment services' means a procedure intended to treat cancer of the human

ned and dedicated specifically for mammography, in order to detect unsuspected breast cancer. (d) 'Breast cancer outpatient treatment services' means a procedure intended to treat cancer of the human breast, delivered on an outpatient basis, including but not limited to surgery, radiation therapy, chemotherapy, hormonal therapy, and related medical follow-up services. (4) This section shall take effect November 1, 1989. History: Add. 1989, Act 57, Eff. Nov. 1, 1989 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350