This cause came on for hearing to consider the
adoption of Mississippi Department of Insurance Proposed Regulation No.
2000-3, entitled "Women's Health and Cancer Rights", and the Commissioner
of Insurance ("Commissioner"), having provided interested parties with
the opportunity to submit written comments, and having held a public hearing
and heard the comments of all interested parties and the evidence produced
by such parties, finds as follows, to-wit:
That on or about June 6, 2000, the Commissioner,
or his duly appointed representative, pursuant to the provisions of Miss.
Code Ann. § 25-43-7(1)
(Rev. 1999), filed with the Secretary of State of the State of Mississippi
notice that said Commissioner, or his duly appointed representative, would
hold a public hearing on Tuesday, July 11, 2000, at 10:00 a.m., in the
Offices of the Commissioner, 18th Floor, Walter Sillers State Office Building,
550 High Street, Jackson, Hinds County, Mississippi, to afford all interested
persons the opportunity to submit testimony and evidence and to give opinions,
make comments, suggestions or objections concerning proposed Regulation
2000-3.
That the Commissioner, or his duly appointed representative,
pursuant to the provisions of Miss. Code Ann. § 25-43-7(l)
(Rev. 1999), mailed, postage prepaid, copies of an Administrative Procedures
Filing Notice and Notice of Hearing to all persons who had
made a timely request of the Mississippi Department of Insurance for advance
notice of said Department's rule-making proceedings.
That pursuant to said Notice of Hearing, a public
hearing was held before the Commissioner, or his duly appointed representative,
on Tuesday, July 11, 2000, at 10:00 a.m., in the Offices of the Commissioner,
18th Floor, Walter Sillers State Office Building, Jackson, Hinds County,
Mississippi, in which all interested parties were given an opportunity
to present their views, opinions, suggestions, comments or objections relative
to proposed Regulation 2000-3.
That the Commissioner, after having considered all relevant evidence, is of the opinion that it would be in the public interest to adopt Mississippi Department of Insurance Regulation 2000-3, entitled "Women's Health and Cancer Rights".
IT IS, THEREFORE, ORDERED that Mississippi Department of Insurance Regulation No. 2000-3, a copy of which is attached hereto as Exhibit "A", and made a part hereof as if copied herein in words, lines and figures, should be and same is hereby adopted, to be effective thirty days from and after its filing with the Office of the Secretary of State of the State of Mississippi.
IT IS FURTHER ORDERED that any interested person or party who feels they will be adversely affected by this Order shall have ten (10) days from the date of this Order in which such adversely affected person or party may file with the Commissioner a written statement outlining how such person or party will be adversely affected and their reasons for review of this Order.
SO ORDERED this the 26th day of July, 2000.
GEORGE DALE
COMMISSIONER OF INSURANCE
___________________________
Table of Contents
Section 1. Authority
Section 2. Purpose and Intent
Section 3. Definition of Health Insurance
Issuer
Section 4. Benefit Requirements
Section 5. Prohibited Practices
Section 6. Notice
Section 7. Exceptions
Section 8. Effective Date
Section 1. Authority
This Regulation is promulgated pursuant to the authority vested in the Commissioner of Insurance under Miss. Code Ann. §§ 83-1-43 and 83-5-1 (Rev. 1999), and is promulgated in accordance with Mississippi Insurance Department Regulation No. 88-101, said Regulation being the Rules of Practice and Procedure Before the Mississippi Insurance Department.
Section 2. Purpose and Intent
In order to fully comply with the Health Insurance Portability and Accountability Act of 1996, as Amended, including instructions issued by the Health Care Financing Administration regarding the enforcement thereof, this Regulation is promulgated to require health insurance issuers in the group and individual markets that cover medical and surgical benefits with respect to a mastectomy to cover, for patients who so elect:
(b) Surgery and reconstruction of the other breast to produce a symmetrical appearance;
(c) Prosthesis, and physical complications of mastectomy, including lymphedema.
As used in this Regulation, the term "health insurance issuer" shall mean any insurance company, hospital or medical service plan or any entity defined in Miss. Code Ann. § 83-41-303(n) (Rev. 1999), which offers group or individual health insurance coverage in the State of Mississippi.
Section 4. Benefit Requirements
A health insurance issuer providing group or individual health insurance coverage that provides medical and surgical benefits with respect to a mastectomy shall provide an insured or enrollee who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy, coverage for all stages of reconstruction of the breast on which the mastectomy has been performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and prostheses and physical complications of mastectomy, including lymphedema in a manner determined in consultation with the attending physician and the patient. Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the coverage. Written notice of the availability of such coverage shall be delivered to the insured in the case of an individual policy, and to the certificate holder in the case of a group policy, upon enrollment and annually thereafter.
Section 5. Prohibited Practices
A. A health insurance issuer offering group or individual health insurance coverage may not:
(b) Penalize or otherwise reduce or limit the reimbursement of an attending provider or provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an insured or enrollee in a manner inconsistent with this Regulation.
Section 6. Notice
A health insurance issuer providing group or individual health insurance coverage shall provide notice to the named insured in the case of an individual policy, and to each certificate holder in the case of a group policy, regarding the coverage required by this Regulation. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the health insurance issuer and shall be transmitted to the named insured or certificate holder not later than October 1, 2000. The notice prescribed by this Section 6. shall be filed with and approved by the Commissioner of Insurance before distribution by the health insurance issuer.
Section 7. Exceptions
This Regulation does not apply to any group health insurance coverage in relation to its provision of excepted benefits described in 42 U.S.C. § 300gg-21(c) and (d), and does not apply to any individual health insurance coverage in relation to its provision of excepted benefits described in 42 U.S.C. § 300gg-63.
Section 8. Effective Date
The effective date of this Regulation shall be thirty (30) days from and after its adoption and filing with the Secretary of State of the State of Mississippi.
GEORGE DALE
COMMISSIONER OF INSURANCE