New Guidance on Administration of Health Care Plans


This update describes two recent developments that may affect the administration of your health care plans.

New Guidance on the Women.s Health and Cancer Rights Act of 1998

Last October, the Departments of Labor and Health Human Services published general guidance on the Women.s Health and Cancer Rights Act of 1998. This Act requires that all group health plans, HMOs and issuers of group and individual health insurance policies that cover mastectomies must also provide benefits for certain reconstructive and related services following a mastectomy.

The law imposes several special notice requirements on health plans. The new guidance clarifies that these notices do not have to be sent separately, but may be included in a summary plan description, a summary of material modification, open enrollment materials, or other written communications by the plan. In addition, the guidance describes the information that must be included in the enrollment notice, and provides a model annual notice that can be used to comply with the Act. A copy of the model annual notice is provided below.

You should check with whoever is administering your medical plan to make sure that these notices are being distributed when required.

National Medical Child Support Notice.

In November of 1999, the Departments of Labor and Health Human Services issued proposed rules that would establish nationwide uniformity over how states inform health care plans about medical child support orders. The rules would require that such orders be submitted first to the employer rather than the plan administrator.

The rules, which are designed to improve enforcement of medical child support orders and reduce costs for plans, include a model national medical support notice. Each state is required to enact laws requiring the use of the model notice to enforce medical child support obligations of parents. This requirement is effective for each state on or after October 1, 2001, depending on the date the State legislature implements the Child Support Performance and Incentive Act.

The Notice has two parts. Part A, the .Employer Withholding Notice,. informs the employer that a medical child support order has been issued with respect to one of its employees, and explains the employer.s obligations. Part B, the .Medical Support Notice to Plan Administrator. is to be sent by the employer to the plan.s administrator to initiate coverage for the dependent. Any Notice issued using the model form will be presumed to constitute a .qualified. medical child support order that must be accepted by the employer and the plan if the model form has been completed properly.

The model Notice was published in the Appendix to the Proposed Rules at 64 Federal Register 62064 (Nov. 15, 1999) and is available through the Department of Labor.s web site at http://www.dol.gov/dol/pwba/public/regs/fedreg/proposed/99029412.pdf. (It will probably take a while to download the PDF file because of the graphics in the document.)



MODEL ANNUAL NOTICE

Version 1:

Women.s Health and Cancer Rights Act of 1998 Model Annual Notice

Did you know that your plan, as required by the Women.s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy (including lymphedema)? Call your Plan Administrator ([insert phone number] for more information.

Version 2:

Important Notice About Your Rights Under Your Group Health Plan:

October is National Breast Cancer Awareness Month. Your plan, [or identify plan by name], provides benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy (including lymphedema). Keep this notice for your records and call your Plan Administrator for more information.