Breast Cancer Patient Protect Act of 2016
This bill amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require a group or individual health plan that provides medical and surgical benefits to ensure that inpatient (and in the case of a lumpectomy, outpatient) coverage and radiation therapy are provided for breast cancer treatment. Such a plan may not: (1) restrict benefits for any medically necessary hospital stay to less than 48 hours for a mastectomy or breast conserving surgery or less than 24 hours for a lymph node dissection, or (2) require that a provider obtain authorization from the plan for prescribing any such hospital stay.
Such a plan must: (1) provide notice to each participant and beneficiary regarding the coverage required under this bill, and (2) ensure that coverage is provided for secondary consultations.
Health plans are prohibited from taking specified actions to avoid the requirements of this bill.
Health insurers that provide individual health insurance coverage may discontinue an individual's coverage based on the intentional concealment of material facts regarding a health condition related to a condition for which coverage is being claimed.
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