TO MANDATE COVERAGE FOR BREAST RECONSTRUCTION SURGERIES; TO REQUIRE PRIOR AUTHORIZATION FOR BREAST RECONSTRUCTION SURGERIES; AND TO ESTABLISH A MINIMUM REIMBURSEMENT RATE FOR BREAST RECONSTRUCTION SURGERIES.

segalco.com PURPOSE OF BILL: SB 83 To mandate coverage for breast reconstruction surgeries; to require prior authorization for breast reconstruction surgeries; and to establish a minimum reimbursement rate for breast reconstruction surgeries. ACTUARIAL STATEMENT The Fiscal Impact Statement was prepared according to generally accepted actuarial principles and practices, in compliance with ACT 112. The Statement provides an estimate of the financial and actuarial effect of the proposed change(s) on the Plans, if possible. The Statement makes no comment or opinion with regard to the merits of the measure for which the Statement is prepared; however, any identified technical or mechanical defects have been noted. We have reviewed the input and results of our analysis for reasonableness and relied upon the data and information provided by the Plans and their Claims Processing Contractors. 3/12/2025 _________________________________________ _________________ Patrick Klein, FSA, MAAA Date Vice President, Segal 3/12/2025 _________________________________________ __________________ Matthew Kersting, FSA, MAAA Date Vice President, Segal PROJECTED COSTS Plan Design Change Estimated Cost/(Savi