Breast Reconstruction. Reconstruction of the breast on which a mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and physical complications of all states of mastectomy, including lymphedemas, are covered. Such re-constructive procedures are not limited to re-constructive procedures necessitated by mastectomies performed while covered under this Plan.
Breast Reconstruction. If a Member receives Benefits in connection with a mastectomy and the Member elects breast reconstruction in connection with such mastectomy, to the extent required by federal law, the Plan provides Benefits for, in a manner determined in consultation with the attending Physician and the Member:
Breast Reconstruction. The Women’s Health and Cancer Rights Act of 1998 requires this notice. This Act is effective for plan year anniversaries on or after Oct. 21, 1998. (Thus, it affects your health plan upon its anniversary/renewal date or at the time of purchase for new accounts.) This benefit may already be included as part of your coverage. In the case of a covered person receiving benefits under their plan in connection with a mastectomy and who elects breast reconstruction, coverage will be provided in a manner determined in consultation with the attending physician and the patient for: S Reconstruction of the breast on which the mastectomy was performed S Surgery and reconstruction of the other breast to produce a symmetrical appearance S Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas. Deductibles, coinsurance and copayment amounts will be the same as those applied to other similarly covered medical services, such as surgery and prostheses.
Breast Reconstruction. If a Member receives Benefits in connection with a mastectomy and the Member elects breast reconstruction in connection with such mastectomy, to the extent required by federal law, the Plan provides Benefits for, in a manner determined in consultation with the attending Physician and the Member, and is medically necessary:
1. All stages of reconstruction of the breast on which a mastectomy has been performed;
2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
3. Prostheses and physical complications of the mastectomy, including lymphedemas. Coverage for external breast prostheses is limited to two (2) prostheses per breast, per Calendar Year. The Maximum Allowed Amount for breast prostheses includes the cost of fitting for the prosthesis. The Plan provides Benefits for post- mastectomy bras worn with breast prosthesis. Coverage for post-mastectomy bras is limited to three (3) bras per Member, per Calendar Year. Breast construction is covered when Medically Necessary and performed during Gender Affirming surgery. Cosmetic breast reconstruction is not covered under the Plan. This includes but is not limited to: reconstruction of a previously reconstructed breast due to normal aging; reconstruction of a breast that was not the result of a mastectomy; and replacement of an existing breast implant if the earlier breast implant was performed as a cosmetic procedure.
Breast Reconstruction. If a Member receives Benefits in connection with a mastectomy and the Member elects breast reconstruction in connection with such mastectomy, to the extent required by federal law, the Plan provides Benefits for, in a manner determined in consultation with the attending Physician and the Member:
1. All stages of reconstruction of the breast on which a mastectomy has been performed;
2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
3. Prostheses and physical complications of the mastectomy, including lymphedemas. Coverage for external breast prostheses is limited to two (2) prostheses per breast, per Calendar Year. The Maximum Allowed Amount for breast prostheses includes the cost of fitting for the prosthesis. The Plan provides Benefits for post-mastectomy bras worn with breast prosthesis. Coverage for post-mastectomy bras is limited to three (3) bras per Member, per Calendar Year. Breast construction is covered when Medically Necessary and performed during Gender Confirming surgery. Cosmetic breast reconstruction is not covered under the Plan. This includes, but is not limited to: reconstruction of a previously reconstructed breast due to normal aging; reconstruction of a breast that was not the result of a mastectomy; and replacement of an existing breast implant if the earlier breast implant was performed as a cosmetic procedure.
