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Women's Health and Cancer Rights Act

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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).