Annual Coverage Notice Regarding Breast Reconstruction Surgery



October is Breast Cancer Awareness Month. The Women's Health and Cancer Rights Act of 1998 requires group health plans (and health insurance issuers) that provide medical and surgical benefits for mastectomies to offer certain benefits to a participant who is having a mastectomy and elects breast reconstruction as follows:

  • All stages of 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 treatment for physical complications of all stages of mastectomy, including lymphedemas.

The plan or insurer is required to provide written annual notice of this coverage to participants and beneficiaries under the plan. The notice must be prominently displayed in materials distributed to participants. Although the notice does not have to be provided in October, this is an appropriate time to send it out.

If you have any questions about the notice requirement or would like to receive a form of notice for participants, please let us know.