Common use of Breast Reconstruction Clause in Contracts

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, 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- post‐ mastectomy bras worn with breast prosthesis. Coverage for post-mastectomy 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, 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. SAMPLE 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, and is medically necessary: 1. a. All stages of reconstruction of the breast on which a mastectomy has been performed; 2. b. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3. c. 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- post‐ mastectomy bras worn with breast prosthesis. Coverage for post-mastectomy 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.