§1077.3. Required coverage for a patient's choice of medical and surgical treatments following a diagnosis and treatment of cancer

            A. The purpose of this Section is to stress that decisions regarding the treatment procedures to be performed following a diagnosis of cancer shall be made solely by the patient in consultation with attending physicians and to clarify that all levels of medical and surgical treatment as provided for in this Section are medically necessary and shall not be excluded from coverage. Consulting physicians shall consider recognized, evidence-based standards such as the guidelines of the National Comprehensive Cancer Network in making treatment recommendations.

            B.(1) Any health benefit plan offered by a health insurance issuer that provides medical and surgical benefits with respect to treatment for cancer shall provide coverage for the medical and surgical treatment corresponding to urinary and sexual dysfunction resulting from the treatments, chosen by a patient diagnosed with cancer in consultation with the attending physician.

            (2) A health benefit plan offered by a health insurance issuer that provides medical and surgical benefits with respect to cancer treatment shall not deny coverage for those procedures correcting urinary and sexual dysfunction resulting from treatments, including penile injections, external pumps, and surgical implants, as chosen by a patient diagnosed with and treated for cancer in consultation with the attending physician.

            C. For purposes of this Section, the following terms have the following meanings:

            (1) "Health benefit plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan and the Office of Group Benefits programs. "Health benefit plan" does not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, and short-term policies that have a term of less than twelve months.

            (2) "Health insurance issuer" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including through a health benefit plan as defined in this Section, and includes a sickness and accident insurance company, a health maintenance organization, a preferred provider organization, or any similar entity, or any other entity providing a plan of health insurance or health benefits.

            Acts 2024, No. 621, §1.