Provisions of the act

The Act requires group health plans to cover reconstructive breast surgery following a mastectomy.

Specific requirements

The following services and procedures must be covered in connection with a mastectomy.

• 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

• Prostheses and physical complications of mastectomy, including lymphedemas.

All plans are required to notify participants and beneficiaries about the reconstructive breast surgery coverage requirement. The notice must be in writing as part of any yearly informational packet sent tot he participants or beneficiaries.