The Women's Health and Cancer Rights Act of 1998 requires
coverage of treatment related to mastectomy.
The Women's Health and Cancer Right Act of 1998 was a part of the omnibus
appropriations bill passed by Congress and signed by President Clinton on
October 21, 1998. The law applies to insured and self-insured plans and HMOs
provided by private and governmental employees. For women who are eligible for
mastectomy benefits under their group medical coverage and who elect breast
reconstruction in connection with such mastectomy, the law requires the
following coverage:
Reconstruction of the breast on which mastectomy has been performed;
Surgery and reconstruction on the other breast to produce a symmetrical
appearance;
Prostheses; and
Treatment for physical complications of all stages of mastectomy, including
lymphademas.
Coverage for reconstructive breast surgery may not be denied or reduced on
the grounds that it is cosmetic in nature or that it otherwise does not meet
the coverage definition of "medically necessary." Benefits must be
provided on the same basis as for any other illness or injury under the medical
plan. Coverage is effective January 1, 1999. In addition, all group
health plans and health insurance insurers must provide plan participants with
written notice of the coverage no later than Jan. 1, 1999.
Employers who offer insured plans or HMOs are urged to contact their
carriers to make sure they are prepared to comply (or already have complied)
with these requirements. Employers should also ensure that their insurance or
HMO contracts, summary plan descriptions, and plan documents are amended as
soon as possible.
