WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 NOTICE
Under federal law, group health plans, insurers, and HMOs that provide medical and surgical benefits in connection with a mastectomy must provide benefits for certain reconstructive surgery, effective for the first plan year beginning on or after October 21, 1998. In the case of a participant or beneficiary who is receiving benefits under the plan in connection with a mastectomy and who elects breast reconstruction, federal law requires coverage in a manner determined in consultation with the attending physician and the patient for:
- reconstruction of the breast on which the mastectomy was performed;
- surgery and reconstruction of the other breast to produce a symmetrical appearance; and
- Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedema.
This coverage is subject to a plan’s annual deductibles and coinsurance provisions. These provisions are generally described in the plan’s Summary Plan Description (SPD).
If you have any questions about the coverage of mastectomies or reconstructive surgery, please contact your Local Port Administrator or the MILA office.
