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 Oct. 21, 1998. The law applies to insured and self-insured plans and HMOs provide 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 Jan. 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.

HCFA Medicare Screening Mammogram Coverage

On May 4, 2000, HCFA issued a press release reminding Americans that coverage for annual screening mammograms is now available for women over age 40 who are enrolled in the Medicare program. The expanded coverage is mandated under the Balanced Budget Act (BBA) of 1997, which is increased Medicare coverage for screening mammograms from once every two years to annually. Under the law, Medicare pays 80 percent of the approved amount for a screening mammogram, and patients pay the remaining 20 percent.

For more information, visit the Medicare website. In addition, please contact Breast Care Service 865.305.6921 or toll-free 1.866.337-8824, ext. 6921.