On Apr. 7, ARK LEG enacted bill on reconstruction surgery coverage.
ARK LEG enacted bill SB 83 related to coverage for breast reconstruction surgeries.
Amends ARK INS 23-3-79 by adding subchapters on breast reconstruction surgery.
Bill Provisions
Requires health benefit plans to provide coverage for breast reconstruction surgery, any surgery determined as the best course of treatment by a healthcare professional.
Subject to policy deductibles, copayment, or coinsurance requirements of insurer at a cost no more than costs associated with plan's in-network rate for healthcare service.
Coverage shall not diminish or limit benefits otherwise allowable under health benefit plan and shall not affect enrollee's eligibility or continued eligibility to renew coverage.
If enrollee is forced to use out-of-network provider due to healthcare insurer's network inadequacy, the enrollee's financial responsibility shall remain at an in-network rate.
Healthcare insurer shall require prior authorization for breast reconstruction surgery.
If no participating provider, healthcare insurer that provides a prior authorization or predetermination shall automatically approve a single case agreement at same rate.
Establishes minimum reimbursement rates, penalties for late payment or nonpayment.
Legislative History
On Jan. 21, 2025, bill was introduced in Senate; on Mar. 20, 2025, bill passed Senate.
On Mar. 20, 2025, bill was introduced in House; on Apr. 1, 2025, bill passed House.
On Apr. 7, 2025, bill was signed into law by the governor and assigned Act 424.
Effectiveness
Act effective 91 days after legislature adjourned sine die (May 5), so Aug. 4, 2025.
Regulators
ARK LEG
Entity Types
Ins
Reference
Act 424, Bill SB83, 4/7/2025; Citation: ARK INS 23-3-79;
