Women's Health and Cancer Rights Act
On October 21, 1998, a new federal law entitled the "Women's Health
and Cancer Rights Act" became effective. It requires group health
plans sponsored by public and private employers to provide coverage
for certain reconstructive surgery follows mastectomy. It's effective
for group plans as of the first plan year beginning on or after
October 21, 1998 (the date it was signed). There is no delayed effective
date for collectively bargained plans. (The new law also applies
to individual insurance products, for which the effective date is
October 21, 1998.)
The new law also requires that the insurer or HMO send you a notice
explaining the required benefits. They must send this initial notice
before January 1, 1999 [for plan years beginning on or after October
21, 1998 and on or before January 1, 1999] and they must notify
you annually at each open enrollment.
The specific requirements of the new law are that a plan which
provides medical and surgical benefits for mastectomies must cover
the following benefits for a member who undergoes a medically necessary
mastectomy and who elects breast reconstruction after surgery:
- reconstruction of the breast on which the mastectomy was performed;
- surgery and reconstruction of the other breast to achieve a
symmetrical appearance, and
- prostheses and treatment of treatment of physical complications
of all stages of the mastectomy, including lymphedemas.
This coverage will be provided as determined by the attending physician
in consultation with the patient, and will be provided in a manner
consistent with that applicable to other benefits (e.g., same annual
deductibles and cost sharing provisions that apply for other benefits).
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