As we advised in our previous Alert dated December 7, 1998, all group health plans are required to notify their participants of the availability of certain newly-mandated benefits related to reconstructive surgery following mastectomy. This notice must be sent to all participants NO LATER THAN January 1, 1999. In order to assist you in complying with this statutory requirement, we have attached a sample notice for your use. Please contact us if you have any questions concerning your obligations under the Act.
For more information, contact
Briggs and Morgan's Employee Benefits Group:
- Carolyn Nestingen
- (612) 334-8579
- Wendy Citron
- (612) 334-8675
TO: All Members of the Minnesota State Health Plan/Minnesota State Health Plan Select
FROM: Plan Administrator
DATE: ________________________
RE: Women's Health and Cancer Rights Act of 1998
On October 21, 1998, Congress enacted the Women's Health and Cancer Rights Act of 1998. This notice explains the most important provisions of the Act. Please review this information carefully. If your spouse is covered under the Minnesota State Health Plan or the Minnesota State Health Plan Select, please make certain that she or he also has the opportunity to review this information.
The Women's Health and Cancer Rights Act of 1998 requires that all group health plans that provide medical and surgical benefits for a mastectomy also must provide coverage for:
- reconstruction of the breast on which the mastectomy has been performed;
- surgery and reconstruction of the other breast to produce a symmetrical appearance; and
- prostheses and coverage for any complications in all stages of mastectomy, including lymphedamus.
The Act requires that coverage be provided in a manner that is consistent with other benefits provided under the Plan. The coverage may be subject to annual deductibles and coinsurance provisions.
The Act prohibits any group health plan from:
- denying a participant or a beneficiary eligibility to enroll or renew coverage under the plan in order to avoid the requirements of the Act;
- penalizing, reducing, or limiting reimbursement to the attending provider (e.g., physician, clinic or hospital) to induce the provider to provide care inconsistent with the Act; and
- providing monetary or other incentives to an attending provider to induce the provider to provide care inconsistent with the Act.
The Women's Health and Cancer Rights Act of 1998 will apply to the Minnesota State Health Plan and the Minnesota State Health Plan Select on the effective date of your 1999 coverage (January 1, 1999, January 4, 1999, or January 6, 1999).
Please keep this information with your other group health plan documents. If you have any questions about this Plan's coverage of mastectomies and reconstructive surgeries, please call ______________________________________. The next Certificate of Coverage you receive will include updated information about this coverage.